Healthcare Provider Details

I. General information

NPI: 1518606862
Provider Name (Legal Business Name): CHRISTIAN OGASAWARA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

301 UNIVERSITY BLVD
GALVESTON TX
77555-5302
US

IV. Provider business mailing address

215 POST OFFICE ST APT 403
GALVESTON TX
77550-5671
US

V. Phone/Fax

Practice location:
  • Phone: 808-388-1421
  • Fax:
Mailing address:
  • Phone: 808-388-1421
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License NumberBP10079539
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: