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General NPI Number Information
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NPI Number | 1730596495
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Entity Type | Organization
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Legal Business Name | WOGU & WOGU NEUROSURGICAL AND SPINE SERVICES INC
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Dates
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Enumeration Date | 07/15/2014
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Last Update Date | 09/14/2018
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Provider Practice Location Address
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Address Line | 620 CALIFORNIA BLVD STE J
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City | SAN LUIS OBISPO
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State | CA
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Zip | 93401-2598
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Country | US
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Telephone | 805-543-9648
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Fax | 805-543-1879
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Provider Business Mailing Address
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Address Line | 1655 DALIDIO DR UNIT 4156
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City | SAN LUIS OBISPO
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State | CA
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Zip | 93403-7036
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Country | US
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Telephone | 805-543-9648
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Fax | 805-543-1879
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Authorized Official
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Title or Position | NEUROSURGEON
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Name | DR. ELIJAH UZOMA WOGU
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Credential | DO
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Telephone | 951-288-0061
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207T00000X
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Taxonomy Name | Neurological Surgery Physician
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License Number | 20A9318
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License Number State | CA
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