Provider Demographics
NPI:1912767526
Name:OGBEIDE, EFOSA DESTINY
Entity Type:Individual
Prefix:
First Name:EFOSA
Middle Name:DESTINY
Last Name:OGBEIDE
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 1:3718 AUTUMNCREST ST
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:TX
Mailing Address - Zip Code:76065-7171
Mailing Address - Country:US
Mailing Address - Phone:417-450-9849
Mailing Address - Fax:
Practice Address - Street 1:3718 AUTUMNCREST ST
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:TX
Practice Address - Zip Code:76065-7171
Practice Address - Country:US
Practice Address - Phone:417-450-9849
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-20
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide