Provider Demographics
NPI:1326503087
Name:OGBU, IRICA
Entity Type:Individual
Prefix:
First Name:IRICA
Middle Name:
Last Name:OGBU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6802 UTSA BLVD APT 3107
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78249-1551
Mailing Address - Country:US
Mailing Address - Phone:903-386-8994
Mailing Address - Fax:
Practice Address - Street 1:2040 BABCOCK RD STE 304
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-4428
Practice Address - Country:US
Practice Address - Phone:210-731-9570
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-07
Last Update Date:2019-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX344215164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse