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General NPI Number Information
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NPI Number | 1821772674
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Entity Type | Individual
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Provider Name | JESSICA OGUNDUYILE
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Gender | Female
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Dates
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Enumeration Date | 06/12/2023
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Last Update Date | 12/05/2024
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Provider Practice Location Address
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Address Line | 780 E GILBERT ST, SAN BERNADINO
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City | SAN BERNARDINO
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State | CA
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Zip | 92404
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Country | US
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Telephone | 909-387-7194
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Fax |
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Provider Business Mailing Address
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Address Line | 1950 S SUNWEST LN STE 200
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City | SAN BERNARDINO
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State | CA
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Zip | 92408-3248
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Country | US
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Telephone | 909-252-4017
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Fax | 909-252-4055
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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 | 104100000X
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Taxonomy Name | Social Worker
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State | CA
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