Healthcare Provider Details

I. General information

NPI: 1154612760
Provider Name (Legal Business Name): ADANNA C UKAZU MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2011
Last Update Date: 07/12/2023
Certification Date: 07/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12000 RICHMOND AVE STE 215
HOUSTON TX
77082-2428
US

IV. Provider business mailing address

2238 ALMOND CREEK LN
BROOKSHIRE TX
77423-2983
US

V. Phone/Fax

Practice location:
  • Phone: 979-267-0368
  • Fax: 917-900-1547
Mailing address:
  • Phone: 979-267-0368
  • Fax: 917-900-1547

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number25MA09494300
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code2083A0300X
TaxonomyAddiction Medicine (Preventive Medicine) Physician
License NumberS8781
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberS8781
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: