Provider Demographics
NPI:1538896568
Name:UGBEME, OGHENEMARO CECILIA
Entity type:Individual
Prefix:MS
First Name:OGHENEMARO
Middle Name:CECILIA
Last Name:UGBEME
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 1:1208 CARNATION DR
Mailing Address - Street 2:
Mailing Address - City:CROWLEY
Mailing Address - State:TX
Mailing Address - Zip Code:76036-4391
Mailing Address - Country:US
Mailing Address - Phone:510-574-5761
Mailing Address - Fax:
Practice Address - Street 1:1208 CARNATION DR
Practice Address - Street 2:
Practice Address - City:CROWLEY
Practice Address - State:TX
Practice Address - Zip Code:76036-4391
Practice Address - Country:US
Practice Address - Phone:510-574-5761
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-01
Last Update Date:2025-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1182241363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty