Provider Demographics
NPI:1568669125
Name:OGANS, GERALDINE A (CADCA)
Entity Type:Individual
Prefix:
First Name:GERALDINE
Middle Name:A
Last Name:OGANS
Suffix:
Gender:F
Credentials:CADCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:641 W. OAKMONT AVENUE
Mailing Address - Street 2:
Mailing Address - City:PORTERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:93257
Mailing Address - Country:US
Mailing Address - Phone:559-781-6219
Mailing Address - Fax:559-791-0183
Practice Address - Street 1:317 W HENDERSON AVE
Practice Address - Street 2:
Practice Address - City:PORTERVILLE
Practice Address - State:CA
Practice Address - Zip Code:93257-1732
Practice Address - Country:US
Practice Address - Phone:559-781-8585
Practice Address - Fax:559-791-0183
Is Sole Proprietor?:No
Enumeration Date:2007-06-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAI8494705101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5442OtherMEDI-CAL