Provider Demographics
NPI:1053722538
Name:OGBEIDE, FESTUS A (RN)
Entity type:Individual
Prefix:MR
First Name:FESTUS
Middle Name:A
Last Name:OGBEIDE
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1937 3RD ST
Mailing Address - Street 2:
Mailing Address - City:WASCO
Mailing Address - State:CA
Mailing Address - Zip Code:93280-1118
Mailing Address - Country:US
Mailing Address - Phone:916-217-7575
Mailing Address - Fax:
Practice Address - Street 1:1937 3RD ST
Practice Address - Street 2:
Practice Address - City:WASCO
Practice Address - State:CA
Practice Address - Zip Code:93280-1118
Practice Address - Country:US
Practice Address - Phone:916-217-7575
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-18
Last Update Date:2014-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA836082163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse