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General NPI Number Information
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NPI Number | 1043817935
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Entity Type | Individual
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Provider Name | JILLIAN MIKA OGATA
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Gender | Female
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Dates
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Enumeration Date | 10/05/2020
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Last Update Date | 12/23/2021
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Provider Practice Location Address
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Address Line | RIVERSIDE UNIVERSITY HEALTH SYSTEM 26520 CACTUS AVE.
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City | MORENO VALLEY
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State | CA
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Zip | 92555
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Country | US
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Telephone | 951-486-4000
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1410
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City | CHINO
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State | CA
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Zip | 91708-1410
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 97251
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License Number State | CA
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