Healthcare Provider Details

I. General information

NPI: 1780216267
Provider Name (Legal Business Name): ANGEL OKOEGUALE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/12/2020
Last Update Date: 02/12/2020
Certification Date: 02/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2626 S LOOP W STE 315
HOUSTON TX
77054-2652
US

IV. Provider business mailing address

10223 BROADWAY ST STE P252
PEARLAND TX
77584-7880
US

V. Phone/Fax

Practice location:
  • Phone: 832-385-1841
  • Fax: 832-485-0595
Mailing address:
  • Phone: 832-385-1841
  • Fax: 832-485-0595

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number41412
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: