Healthcare Provider Details

I. General information

NPI: 1184531535
Provider Name (Legal Business Name): IHEANYI PRINCE OGWURU
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 EVENING SUN DR
PROSPER TX
75078-0438
US

IV. Provider business mailing address

220 EVENING SUN DR
PROSPER TX
75078-0438
US

V. Phone/Fax

Practice location:
  • Phone: 214-283-0129
  • Fax:
Mailing address:
  • Phone: 214-283-0129
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code342000000X
TaxonomyTransportation Network Company
License Number
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: