Healthcare Provider Details

I. General information

NPI: 1679718456
Provider Name (Legal Business Name): ROLAND NNANDI ALABAROAYE CNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/09/2008
Last Update Date: 03/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9802 FORUM PARK DR 3267
HOUSTON TX
77036-8207
US

IV. Provider business mailing address

9802 FORUM PARK DR 3267
HOUSTON TX
77036-8207
US

V. Phone/Fax

Practice location:
  • Phone: 713-550-2847
  • Fax: 832-305-8674
Mailing address:
  • Phone: 713-550-2847
  • Fax: 832-305-8674

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code167G00000X
TaxonomyLicensed Psychiatric Technician
License NumberNA08281159
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: