Healthcare Provider Details

I. General information

NPI: 1568124550
Provider Name (Legal Business Name): MISS CHIKAODILI AFUGBUOM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2021
Last Update Date: 09/24/2024
Certification Date: 09/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1635 S FRY RD
KATY TX
77450-6404
US

IV. Provider business mailing address

25234 LEXINGTON MANOR CT
KATY TX
77493-4627
US

V. Phone/Fax

Practice location:
  • Phone: 281-616-8075
  • Fax:
Mailing address:
  • Phone: 346-204-3985
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-21-187077
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: