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NPI Code Detail

MEDICARE: SOJI OBAGBEMI

MEDICARE: SOJI OBAGBEMI
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103K00000XBehavior Analyst

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1417687765
Entity Type Code : Individual
Provider Name (Legal Business Name) : SOJI OBAGBEMI
Provider Business Mailing Address
First Line : 3920 W CHARLESTON BLVD STE N
Second Line :
City : LAS VEGAS
State : NV
Zip : 89102-1651
Country : US
Telephone Number : 170-282-2044
Fax Number :
Provider Business Practice Location Address
First Line : 3920 W CHARLESTON BLVD STE N
Second Line :
City : LAS VEGAS
State : NV
Zip : 89102-1651
Country : US
Telephone Number : 702-822-0447
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/10/2022
Last Update Date : 06/15/2022

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Directions to “ SOJI OBAGBEMI ” Practice Location

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