Provider Demographics
NPI:1730596495
Name:WOGU & WOGU NEUROSURGICAL AND SPINE SERVICES INC
Entity type:Organization
Organization Name:WOGU & WOGU NEUROSURGICAL AND SPINE SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NEUROSURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:ELIJAH
Authorized Official - Middle Name:UZOMA
Authorized Official - Last Name:WOGU
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:951-288-0061
Mailing Address - Street 1:1655 DALIDIO DR UNIT 4156
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93403-7036
Mailing Address - Country:US
Mailing Address - Phone:805-543-9648
Mailing Address - Fax:805-543-1879
Practice Address - Street 1:620 CALIFORNIA BLVD STE J
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-2598
Practice Address - Country:US
Practice Address - Phone:805-543-9648
Practice Address - Fax:805-543-1879
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-15
Last Update Date:2018-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A9318207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty