Healthcare Provider Details

I. General information

NPI: 1700561834
Provider Name (Legal Business Name): ABAKEO OCHALLA OGUD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2023
Last Update Date: 08/15/2024
Certification Date: 08/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

286 EUCLID AVE STE 207
SAN DIEGO CA
92114-3612
US

IV. Provider business mailing address

286 EUCLID AVE STE 207
SAN DIEGO CA
92114-3612
US

V. Phone/Fax

Practice location:
  • Phone: 619-859-6270
  • Fax: 619-266-0496
Mailing address:
  • Phone: 619-859-6270
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number124924
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: