Healthcare Provider Details

I. General information

NPI: 1023929346
Provider Name (Legal Business Name): EDWIN ISRAEL OGUTU
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2026
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 LAWRENCE EXPY
SANTA CLARA CA
95051-5173
US

IV. Provider business mailing address

1313 MARCELLO DR
SAN JOSE CA
95131-1773
US

V. Phone/Fax

Practice location:
  • Phone: 408-851-1000
  • Fax:
Mailing address:
  • Phone: 201-702-6389
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR51029
License Number StateND
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number718667
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95205043
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: