Provider Demographics
NPI:1689902868
Name:OGBOLUGO, CELESTINA
Entity type:Individual
Prefix:
First Name:CELESTINA
Middle Name:
Last Name:OGBOLUGO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:PRESTONWOOD
Other - Middle Name:
Other - Last Name:HOME HEALTHCARE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1140 EMPIRE CENTRAL DR
Mailing Address - Street 2:# 350
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75247-4322
Mailing Address - Country:US
Mailing Address - Phone:469-757-4217
Mailing Address - Fax:972-745-2390
Practice Address - Street 1:1140 EMPIRE CENTRAL DR.
Practice Address - Street 2:# 350
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75247
Practice Address - Country:US
Practice Address - Phone:469-757-4217
Practice Address - Fax:972-745-2390
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-25
Last Update Date:2018-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX251E00000X, 3747P1801X
TXAP136081363LG0600X
3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No251E00000XAgenciesHome Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology