Healthcare Provider Details

I. General information

NPI: 1932069929
Provider Name (Legal Business Name): DESMOND ENYINNAYA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/13/2025
Last Update Date: 11/13/2025
Certification Date: 11/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15530 ELLA BLVD APT 1410
HOUSTON TX
77090-5317
US

IV. Provider business mailing address

15530 ELLA BLVD APT 1410
HOUSTON TX
77090-5317
US

V. Phone/Fax

Practice location:
  • Phone: 346-742-7599
  • Fax: 866-500-2186
Mailing address:
  • Phone: 346-742-7599
  • Fax: 866-500-2186

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number50675196
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: