Healthcare Provider Details

I. General information

NPI: 1881247211
Provider Name (Legal Business Name): OGHOADENA OGBEIDE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2019
Last Update Date: 07/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 WOODLAND PARK DR APT N103
HOUSTON TX
77077-2292
US

IV. Provider business mailing address

2500 WOODLAND PARK DR APT N103
HOUSTON TX
77077-2292
US

V. Phone/Fax

Practice location:
  • Phone: 832-302-1704
  • Fax:
Mailing address:
  • Phone: 832-302-1704
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: