Provider Demographics
NPI:1942945373
Name:JITE-OGBUEHI, DAVID
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:JITE-OGBUEHI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7315 WOODMAN AVE APT 8
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91405-2774
Mailing Address - Country:US
Mailing Address - Phone:818-534-7783
Mailing Address - Fax:
Practice Address - Street 1:7315 WOODMAN AVE APT 8
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91405-2774
Practice Address - Country:US
Practice Address - Phone:818-534-7783
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-29
Last Update Date:2022-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician