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General NPI Number Information
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NPI Number | 1437680915
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Entity Type | Individual
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Provider Name | MATTHEW TAIWO ABIOLA OGBEIDE MD
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Gender | Male
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Dates
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Enumeration Date | 03/25/2017
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Last Update Date | 01/31/2025
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Provider Practice Location Address
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Address Line | 10621 CHURCH ST STE 120
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91730-6834
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Country | US
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Telephone | 909-944-0486
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Fax |
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Provider Business Mailing Address
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Address Line | 837 LAPWING RD
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City | EDMOND
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State | OK
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Zip | 73003-4822
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Country | US
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Telephone | 405-916-6366
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 162281
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License Number State | CA
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