Provider Demographics
NPI:1124835947
Name:UGBIYOBO, JUSTINA OBUKOKWO
Entity type:Individual
Prefix:
First Name:JUSTINA
Middle Name:OBUKOKWO
Last Name:UGBIYOBO
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 1:1703 HARKER CT
Mailing Address - Street 2:
Mailing Address - City:LATHROP
Mailing Address - State:CA
Mailing Address - Zip Code:95330-8245
Mailing Address - Country:US
Mailing Address - Phone:510-584-1818
Mailing Address - Fax:
Practice Address - Street 1:1703 HARKER CT
Practice Address - Street 2:
Practice Address - City:LATHROP
Practice Address - State:CA
Practice Address - Zip Code:95330-8245
Practice Address - Country:US
Practice Address - Phone:510-584-1818
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-16
Last Update Date:2024-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA780490163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice