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NPI Code Detail

MEDICARE: OBIAGELI MOMODU

MEDICARE: OBIAGELI MOMODU
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
2183500000XPharmacist20461NV

General Provider Information

NPI Number : 1538598651
Entity Type Code : Individual
Provider Name (Legal Business Name) : OBIAGELI MOMODU
Provider Business Mailing Address
First Line : 4905 W TROPICANA AVE
Second Line :
City : LAS VEGAS
State : NV
Zip : 89103-5077
Country : US
Telephone Number : 702-889-0922
Fax Number :
Provider Business Practice Location Address
First Line : 4905 W TROPICANA AVE
Second Line :
City : LAS VEGAS
State : NV
Zip : 89103-5077
Country : US
Telephone Number : 702-889-0922
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/08/2013
Last Update Date : 12/07/2020

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Directions to “ OBIAGELI MOMODU ” Practice Location

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