Healthcare Provider Details

I. General information

NPI: 1285977231
Provider Name (Legal Business Name): CHINONYE CHIKA OGBONNAYA-ODOR M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2013
Last Update Date: 08/13/2023
Certification Date: 08/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

999 E BASSE RD STE 180-472
SAN ANTONIO TX
78209-1801
US

IV. Provider business mailing address

999 E BASSE RD STE 180-472
SAN ANTONIO TX
78209-1801
US

V. Phone/Fax

Practice location:
  • Phone: 210-941-8133
  • Fax: 614-412-9217
Mailing address:
  • Phone: 210-941-8133
  • Fax: 614-412-9217

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberR5300
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberR5300
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: