Healthcare Provider Details

I. General information

NPI: 1376264986
Provider Name (Legal Business Name): OSARENSE WESLEY OSAGIE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/12/2022
Last Update Date: 09/12/2022
Certification Date: 09/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4722 RIVERSTONE BLVD
MISSOURI CITY TX
77459-4723
US

IV. Provider business mailing address

2104 GREENBRIAR DR
SOUTHLAKE TX
76092-8355
US

V. Phone/Fax

Practice location:
  • Phone: 346-368-4412
  • Fax:
Mailing address:
  • Phone: 832-766-2583
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: