Healthcare Provider Details

I. General information

NPI: 1336396381
Provider Name (Legal Business Name): STEPHEN OGAVU
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2008
Last Update Date: 11/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8123 FARTHING LN
ROSHARON TX
77583-6634
US

IV. Provider business mailing address

PO BOX 421854
HOUSTON TX
77242-1854
US

V. Phone/Fax

Practice location:
  • Phone: 832-228-8483
  • Fax:
Mailing address:
  • Phone: 832-228-8483
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number1000163
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: