Healthcare Provider Details

I. General information

NPI: 1740898261
Provider Name (Legal Business Name): ANTHONIA OGAMBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2020
Last Update Date: 07/21/2020
Certification Date: 07/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6516 BROADWAY ST SUITE 112
PEARLAND TX
77581-7880
US

IV. Provider business mailing address

6516 BROADWAY ST SUITE 112
PEARLAND TX
77581-7880
US

V. Phone/Fax

Practice location:
  • Phone: 303-989-8169
  • Fax:
Mailing address:
  • Phone:
  • 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: