Provider Demographics
NPI:1487059382
Name:OGLESBY, ZENA FORD JR
Entity type:Individual
Prefix:
First Name:ZENA
Middle Name:FORD
Last Name:OGLESBY
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8828 MEISENHEIMER AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89143-4412
Mailing Address - Country:US
Mailing Address - Phone:951-534-8061
Mailing Address - Fax:
Practice Address - Street 1:8828 MEISENHEIMER AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89143-4412
Practice Address - Country:US
Practice Address - Phone:951-534-8061
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-04
Last Update Date:2016-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner