=====================================================
General NPI Number Information
=====================================================
NPI Number | 1679431548
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | IKPONMWOSA CHRISTOPHER OGBEIDE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/12/2026
-----------------------------------------------------
Last Update Date | 01/12/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5740 WINDMILL WAY STE 11
-----------------------------------------------------
City | CARMICHAEL
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95608-1379
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 707-704-1521
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5865 61ST ST
-----------------------------------------------------
City | SACRAMENTO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95824-3122
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 707-704-1521
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIEF EXECUTIVE OFFICER
-----------------------------------------------------
Name | DR. IKPONMWOSA CHRISTOPHER OGBEIDE
-----------------------------------------------------
Credential | PSY.D
-----------------------------------------------------
Telephone | 707-704-1521
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 374U00000X
-----------------------------------------------------
Taxonomy Name | Home Health Aide
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------