Healthcare Provider Details

I. General information

NPI: 1235769340
Provider Name (Legal Business Name): RITA OKOGWU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2020
Last Update Date: 02/19/2020
Certification Date: 02/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1155 DAIRY ASHFORD RD STE 560
HOUSTON TX
77079-3035
US

IV. Provider business mailing address

1155 DAIRY ASHFORD RD STE 560
HOUSTON TX
77079-3035
US

V. Phone/Fax

Practice location:
  • Phone: 281-989-8818
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number351802
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: