Individual provider · NPI-1

Ogbanedi John Abu, Physician Assistant

Physician Assistant · Stockton, CA

NPI number1750655353
StatusActive
Last updated in NPPESFeb 28, 2012

Details

NPI
1750655353
Entity type
Individual (NPI-1)
Name
Mr. Ogbanedi John Abu
Credential
Physician Assistant
Sex
Male
Sole proprietor
No
Enumeration date
Feb 28, 2012
Last updated
Feb 28, 2012

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
363A00000X Physician AssistantPA22087CAYes

Practice location

415 W Benjamin Holt Dr
Stockton, CA 95207-3958

Phone 209-477-4103 · Fax 209-477-1065

Mailing address

Po Box 580244
Elk Grove, CA 95758-0005

Phone 209-472-6624 · Fax 209-477-1065

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