Healthcare Provider Details

I. General information

NPI: 1558475335
Provider Name (Legal Business Name): FRANCISCA ADA IFESINACHUKWU M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 03/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4131 SPICEWOOD SPRINGS RD SUITE L 2
AUSTIN TX
78759-8661
US

IV. Provider business mailing address

PO BOX 17906
AUSTIN TX
78760-7906
US

V. Phone/Fax

Practice location:
  • Phone: 512-732-2122
  • Fax: 512-732-2124
Mailing address:
  • Phone: 512-732-2122
  • Fax: 512-732-2124

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberL1620
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberL1620
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: