Provider Demographics
NPI:1164033411
Name:OGBEBOR, AMADIN
Entity Type:Individual
Prefix:MR
First Name:AMADIN
Middle Name:
Last Name:OGBEBOR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 CREEKSIDE RIDGE CT STE 201-15
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95678-3595
Mailing Address - Country:US
Mailing Address - Phone:916-458-1190
Mailing Address - Fax:
Practice Address - Street 1:101 CREEKSIDE RIDGE CT STE 201-15
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95678-3595
Practice Address - Country:US
Practice Address - Phone:916-458-1190
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-11
Last Update Date:2021-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)