Provider Demographics
NPI:1568825081
Name:GAB-OJUKWU, VICTOR (CAO)
Entity Type:Individual
Prefix:
First Name:VICTOR
Middle Name:
Last Name:GAB-OJUKWU
Suffix:
Gender:M
Credentials:CAO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7000 N BROADWAY
Mailing Address - Street 2:SUITE 2-204
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80221
Mailing Address - Country:US
Mailing Address - Phone:720-285-7033
Mailing Address - Fax:720-638-8474
Practice Address - Street 1:7000 N BROADWAY
Practice Address - Street 2:SUITE 2-204
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80221
Practice Address - Country:US
Practice Address - Phone:720-285-7033
Practice Address - Fax:720-638-8474
Is Sole Proprietor?:No
Enumeration Date:2016-04-01
Last Update Date:2016-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO85621552373H00000X, 3747P1801X, 376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No376J00000XNursing Service Related ProvidersHomemaker
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO88981061Medicaid
CO65377869Medicaid
CO85621552Medicaid