Provider Demographics
NPI:1720779184
Name:OGBODO, UZOAMAKA (FNP, PMHNP)
Entity type:Individual
Prefix:
First Name:UZOAMAKA
Middle Name:
Last Name:OGBODO
Suffix:
Gender:
Credentials:FNP, PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8801 RANCH RD
Mailing Address - Street 2:
Mailing Address - City:TRACY
Mailing Address - State:CA
Mailing Address - Zip Code:95304-8116
Mailing Address - Country:US
Mailing Address - Phone:510-520-8952
Mailing Address - Fax:
Practice Address - Street 1:8801 RANCH RD
Practice Address - Street 2:
Practice Address - City:TRACY
Practice Address - State:CA
Practice Address - Zip Code:95304-8116
Practice Address - Country:US
Practice Address - Phone:510-520-8952
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-17
Last Update Date:2025-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95025212363LF0000X, 363LP0808X
CA851853163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health