Provider Demographics
NPI:1942437900
Name:OGINNI, PETER A (OPS MANAGER/OWNER)
Entity Type:Individual
Prefix:MR
First Name:PETER
Middle Name:A
Last Name:OGINNI
Suffix:
Gender:M
Credentials:OPS MANAGER/OWNER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 214913
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95821-0913
Mailing Address - Country:US
Mailing Address - Phone:916-977-0512
Mailing Address - Fax:916-484-1014
Practice Address - Street 1:3400 WATT AVE
Practice Address - Street 2:SUITE101
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95821-3602
Practice Address - Country:US
Practice Address - Phone:916-977-0512
Practice Address - Fax:916-484-1014
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-17
Last Update Date:2009-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA341436332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies