Healthcare Provider Details

I. General information

NPI: 1760001952
Provider Name (Legal Business Name): BLESSING E OGBEMUDIA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2020
Last Update Date: 08/12/2024
Certification Date: 08/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7160 RAFAEL RIVERA WAY STE 210
LAS VEGAS NV
89113-5395
US

IV. Provider business mailing address

PO BOX 840857
DALLAS TX
75284-0857
US

V. Phone/Fax

Practice location:
  • Phone: 702-878-0070
  • Fax: 702-805-0307
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number25706
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: