Provider Demographics
NPI:1982418067
Name:OGATA, JENNIFER (MPT)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:OGATA
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7139 STONEBROOKE DR
Mailing Address - Street 2:
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94591-8703
Mailing Address - Country:US
Mailing Address - Phone:707-548-3633
Mailing Address - Fax:
Practice Address - Street 1:4055 SOLANO AVE
Practice Address - Street 2:
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94558-2232
Practice Address - Country:US
Practice Address - Phone:707-304-5348
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-06
Last Update Date:2025-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT20225208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation