Healthcare Provider Details

I. General information

NPI: 1922305614
Provider Name (Legal Business Name): CARMEN OGEOLAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/16/2011
Last Update Date: 06/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4285 N RANCHO DR
LAS VEGAS NV
89130-3446
US

IV. Provider business mailing address

4777 E FLAMINGO RD
LAS VEGAS NV
89121-4742
US

V. Phone/Fax

Practice location:
  • Phone: 702-385-5331
  • Fax: 702-385-5678
Mailing address:
  • Phone: 702-445-6141
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: