Provider Demographics
NPI:1295452050
Name:OSEMWOTA, OGHOSA
Entity type:Individual
Prefix:
First Name:OGHOSA
Middle Name:
Last Name:OSEMWOTA
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 1:16329 MELLOW OAKS LN
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77498-7213
Mailing Address - Country:US
Mailing Address - Phone:832-387-2295
Mailing Address - Fax:
Practice Address - Street 1:16329 MELLOW OAKS LN
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77498-7213
Practice Address - Country:US
Practice Address - Phone:832-387-2295
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-24
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant