Provider Demographics
NPI:1205350006
Name:USIGBE, OMONIGHO EDITH
Entity type:Individual
Prefix:
First Name:OMONIGHO
Middle Name:EDITH
Last Name:USIGBE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2270 LOSEE RD STE B
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89030-4109
Mailing Address - Country:US
Mailing Address - Phone:702-399-1070
Mailing Address - Fax:702-399-1070
Practice Address - Street 1:2270 LOSEE RD SUITE B
Practice Address - Street 2:SUITE B
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89030
Practice Address - Country:US
Practice Address - Phone:702-399-1070
Practice Address - Fax:702-399-1070
Is Sole Proprietor?:No
Enumeration Date:2017-08-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitation