Healthcare Provider Details

I. General information

NPI: 1124880299
Provider Name (Legal Business Name): JAMES JOSEPH OGDEN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2024
Last Update Date: 02/18/2024
Certification Date: 02/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 E BELLEVUE AVE
SAN MATEO CA
94401-2305
US

IV. Provider business mailing address

1900 VERSAILLES AVE
ALAMEDA CA
94501-1655
US

V. Phone/Fax

Practice location:
  • Phone: 510-295-2698
  • Fax:
Mailing address:
  • Phone: 151-020-5269
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number16478
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: