Provider Demographics
NPI:1487236709
Name:BOGDANOVA, OLENA V
Entity type:Individual
Prefix:
First Name:OLENA
Middle Name:V
Last Name:BOGDANOVA
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 1:7395 FORSUM RD
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95138-1904
Mailing Address - Country:US
Mailing Address - Phone:408-550-3092
Mailing Address - Fax:
Practice Address - Street 1:7395 FORSUM RD
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95138-1904
Practice Address - Country:US
Practice Address - Phone:408-550-3092
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-26
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician