Healthcare Provider Details

I. General information

NPI: 1255909453
Provider Name (Legal Business Name): OGBUGO EMEH MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2021
Last Update Date: 06/21/2021
Certification Date: 06/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 W CHARLESTON BLVD
LAS VEGAS NV
89102-2329
US

IV. Provider business mailing address

3022 S DURANGO DR STE 100
LAS VEGAS NV
89117-4440
US

V. Phone/Fax

Practice location:
  • Phone: 702-383-4000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: OGBUGO EMEH
Title or Position: CEO
Credential: MD
Phone: 650-996-3294