Healthcare Provider Details

I. General information

NPI: 1598929432
Provider Name (Legal Business Name): ENYIBUAKU RITA UZOAGA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2008
Last Update Date: 08/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9119 S GESSNER DR SUITE 305
HOUSTON TX
77074-2874
US

IV. Provider business mailing address

PO BOX 550
INGRAM TX
78025-0550
US

V. Phone/Fax

Practice location:
  • Phone: 713-772-5669
  • Fax: 713-772-5536
Mailing address:
  • Phone: 713-772-5669
  • Fax: 713-772-5536

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number6779
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code111NN0400X
TaxonomyNeurology Chiropractor
License Number6779
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number6779
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberM0297
License Number StateTX
# 5
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License NumberM0297
License Number StateTX

VIII. Authorized Official

Name: DR. ENYIBUAKU RITA UZOAGA
Title or Position: OWNER PROVIDER
Credential: MD
Phone: 713-772-5669