Healthcare Provider Details

I. General information

NPI: 1093167025
Provider Name (Legal Business Name): GLORIA OGABI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/01/2016
Last Update Date: 07/10/2024
Certification Date: 07/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 N 1ST ST
YAKIMA WA
98901-1702
US

IV. Provider business mailing address

26730 196TH AVE SE
COVINGTON WA
98042-6006
US

V. Phone/Fax

Practice location:
  • Phone: 509-248-4510
  • Fax:
Mailing address:
  • Phone: 425-777-6374
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMDCE.ML.61570332
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: