Healthcare Provider Details

I. General information

NPI: 1427307651
Provider Name (Legal Business Name): VALENTINE OSITA OGAMBA NURSE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2012
Last Update Date: 04/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 THE ALAMEDA
SAN JOSE CA
95126-1136
US

IV. Provider business mailing address

456 FONICK DR
SAN JOSE CA
95111-1717
US

V. Phone/Fax

Practice location:
  • Phone: 408-261-7777
  • Fax: 408-254-9960
Mailing address:
  • Phone: 408-836-4041
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License NumberVN259729
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberVN259729
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: