Healthcare Provider Details

I. General information

NPI: 1508671850
Provider Name (Legal Business Name): VICTOR GBEMUDU
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/12/2025
Last Update Date: 02/12/2025
Certification Date: 02/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3001 COLUMBUS AVE
BELLEVUE NE
68005-4117
US

IV. Provider business mailing address

3001 COLUMBUS AVE
BELLEVUE NE
68005-4117
US

V. Phone/Fax

Practice location:
  • Phone: 951-519-4392
  • Fax:
Mailing address:
  • Phone: 951-519-4392
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: