Healthcare Provider Details

I. General information

NPI: 1942939210
Provider Name (Legal Business Name): PRECIOUS NNEDIMMA OGU PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2022
Last Update Date: 03/02/2025
Certification Date: 03/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9321 CERULEAN DR APT 204
RIVERVIEW FL
33578-4767
US

IV. Provider business mailing address

410 S WARE BLVD STE 814
TAMPA FL
33619-4456
US

V. Phone/Fax

Practice location:
  • Phone: 713-498-4229
  • Fax:
Mailing address:
  • Phone: 813-483-9989
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: