Healthcare Provider Details

I. General information

NPI: 1538956529
Provider Name (Legal Business Name): PAUL SUNNY OGBONNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2025
Last Update Date: 04/22/2025
Certification Date: 04/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1658 S FORUM DR APT 4406
GRAND PRAIRIE TX
75052-1145
US

IV. Provider business mailing address

1658 S FORUM DR APT 4406
GRAND PRAIRIE TX
75052-1145
US

V. Phone/Fax

Practice location:
  • Phone: 682-414-9127
  • Fax:
Mailing address:
  • Phone: 682-414-9127
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: