Healthcare Provider Details

I. General information

NPI: 1821800137
Provider Name (Legal Business Name): FAITH O OBAROGIE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2025
Last Update Date: 01/23/2025
Certification Date: 01/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1532 STEWART DR
ROCKWALL TX
75032-6599
US

IV. Provider business mailing address

1532 STEWART DR
ROCKWALL TX
75032-6599
US

V. Phone/Fax

Practice location:
  • Phone: 570-677-9792
  • Fax:
Mailing address:
  • Phone: 570-677-9792
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: