Healthcare Provider Details

I. General information

NPI: 1972311801
Provider Name (Legal Business Name): WINIFRED AMIEZIGUEI OGBALOI BT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/23/2024
Last Update Date: 12/23/2024
Certification Date: 12/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2727 SYNOTT RD APT 1910
HOUSTON TX
77082-3558
US

IV. Provider business mailing address

2727 SYNOTT RD APT 1910
HOUSTON TX
77082-3558
US

V. Phone/Fax

Practice location:
  • Phone: 646-363-9705
  • Fax:
Mailing address:
  • Phone: 646-363-9705
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: