Healthcare Provider Details

I. General information

NPI: 1831818970
Provider Name (Legal Business Name): UGOCHUKWU T OKONKWO PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: UGO OKONKWO PA-C

II. Dates (important events)

Enumeration Date: 08/23/2022
Last Update Date: 07/30/2025
Certification Date: 07/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 MED CT STE 210
SAN ANTONIO TX
78258-3484
US

IV. Provider business mailing address

27595 INTERSTATE 10 W APT 332
BOERNE TX
78006-6638
US

V. Phone/Fax

Practice location:
  • Phone: 210-494-4290
  • Fax: 210-494-4809
Mailing address:
  • Phone: 480-434-9393
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA18793
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: