Healthcare Provider Details

I. General information

NPI: 1053768036
Provider Name (Legal Business Name): CHRISTINE OGUGBUAJA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2016
Last Update Date: 07/18/2024
Certification Date: 07/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 CALIFORNIA ST STE 1400
SAN FRANCISCO CA
94104-2116
US

IV. Provider business mailing address

2986 BERNARD VIEW LN
COLUMBUS OH
43209-2076
US

V. Phone/Fax

Practice location:
  • Phone: 855-527-1850
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0500X
TaxonomyPreventive Medicine/Occupational Environmental Medicine Physician
License Number95653
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: