Provider Demographics
NPI:1508158403
Name:OGUNDIMU, BEATRICE ADENIKE
Entity Type:Individual
Prefix:
First Name:BEATRICE
Middle Name:ADENIKE
Last Name:OGUNDIMU
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 1:204 MARSH AVE
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89509-1652
Mailing Address - Country:US
Mailing Address - Phone:775-972-9191
Mailing Address - Fax:775-972-9191
Practice Address - Street 1:3650 SIENNA VISTA CT
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89512-1370
Practice Address - Country:US
Practice Address - Phone:775-786-1580
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-10
Last Update Date:2011-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner