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General NPI Number Information
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NPI Number | 1699134049
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Entity Type | Organization
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Legal Business Name | ODOBO MEDICAL CONSULTANT INC
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Dates
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Enumeration Date | 02/13/2016
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Last Update Date | 02/13/2016
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Provider Practice Location Address
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Address Line | 10739 BERNINI DR
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City | LAS VEGAS
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State | NV
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Zip | 89141-4259
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Country | US
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Telephone | 678-358-4681
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Fax |
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Provider Business Mailing Address
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Address Line | 10739 BERNINI DR
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City | LAS VEGAS
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State | NV
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Zip | 89141-4259
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Country | US
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Telephone | 678-358-4681
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | EGHOSA ODOBO
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Credential | NP-C
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Telephone | 678-358-4681
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number |
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License Number State | NV
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State | NV
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