Provider Demographics
NPI:1518128883
Name:OGWARO, KISANI (MD)
Entity Type:Individual
Prefix:DR
First Name:KISANI
Middle Name:
Last Name:OGWARO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:KISANI
Other - Middle Name:MARY
Other - Last Name:OGWARO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:298 BERNAL RD
Mailing Address - Street 2:SUITE A; MURIEL WRIGHT CRT
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95119-1809
Mailing Address - Country:US
Mailing Address - Phone:408-638-4744
Mailing Address - Fax:408-780-0755
Practice Address - Street 1:298 BERNAL RD
Practice Address - Street 2:SUITE A; MURIEL WRIGHT CRT
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95119-1809
Practice Address - Country:US
Practice Address - Phone:408-638-4744
Practice Address - Fax:408-780-0755
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-19
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC1630162084P0800X
AZ425422084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZFO1953389OtherDEA
AZAU-2903599-0460OtherDEA