Provider Demographics
NPI:1437212859
Name:OGBUGBULU, JOSEPHINE (OWNER PRESIDENT)
Entity Type:Individual
Prefix:MRS
First Name:JOSEPHINE
Middle Name:
Last Name:OGBUGBULU
Suffix:
Gender:F
Credentials:OWNER PRESIDENT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3534 FREDERICKSBURG RD
Mailing Address - Street 2:STE 1
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78201
Mailing Address - Country:US
Mailing Address - Phone:210-737-2238
Mailing Address - Fax:210-737-6789
Practice Address - Street 1:3534 FREDERICKSBURG RD
Practice Address - Street 2:STE 1
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78201
Practice Address - Country:US
Practice Address - Phone:210-737-2238
Practice Address - Fax:210-737-6789
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX569946163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX569946OtherREGISTER NURSE