Healthcare Provider Details

I. General information

NPI: 1568606697
Provider Name (Legal Business Name): CHINEDUM PEDIATRIC HEALTH PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2009
Last Update Date: 04/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

910 E REDD RD STE P
EL PASO TX
79912-7348
US

IV. Provider business mailing address

910 E REDD RD STE P
EL PASO TX
79912-7348
US

V. Phone/Fax

Practice location:
  • Phone: 915-351-6600
  • Fax: 915-351-6601
Mailing address:
  • Phone: 915-351-6600
  • Fax: 915-351-6601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0201X
TaxonomyPediatric Allergy/Immunology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2080P0208X
TaxonomyPediatric Infectious Diseases Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: FLORENCE O NNEBE
Title or Position: PRESIDENT
Credential: MD
Phone: 915-351-6600