Healthcare Provider Details

I. General information

NPI: 1942016829
Provider Name (Legal Business Name): ENOSADEBA OMOSIGHO ACHA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/05/2024
Last Update Date: 12/05/2024
Certification Date: 12/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8118 FRY RD STE 701
CYPRESS TX
77433-7850
US

IV. Provider business mailing address

8118 FRY RD STE 701
CYPRESS TX
77433-7850
US

V. Phone/Fax

Practice location:
  • Phone: 713-806-5430
  • Fax: 281-815-8537
Mailing address:
  • Phone: 713-806-5430
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: