Provider Demographics
NPI:1457635740
Name:AGBOWO, JOSEPHINE (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPHINE
Middle Name:
Last Name:AGBOWO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2521 SEMINARY AVE
Mailing Address - Street 2:STE 1
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94605-1307
Mailing Address - Country:US
Mailing Address - Phone:510-777-1000
Mailing Address - Fax:510-777-1002
Practice Address - Street 1:2521 SEMINARY AVE
Practice Address - Street 2:STE 1
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94605-1307
Practice Address - Country:US
Practice Address - Phone:510-777-1000
Practice Address - Fax:510-777-1002
Is Sole Proprietor?:No
Enumeration Date:2011-10-05
Last Update Date:2020-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA118389207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine