Healthcare Provider Details

I. General information

NPI: 1942560164
Provider Name (Legal Business Name): MICHELLE LE ANN OGDEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2012
Last Update Date: 05/22/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

737 LOS HUECOS DR
SAN JOSE CA
95123-4636
US

IV. Provider business mailing address

737 LOS HUECOS DR
SAN JOSE CA
95123-4636
US

V. Phone/Fax

Practice location:
  • Phone: 408-649-1199
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: