Healthcare Provider Details

I. General information

NPI: 1750709341
Provider Name (Legal Business Name): CHINELO UDEMGBA AGUOCHA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2014
Last Update Date: 12/10/2021
Certification Date: 12/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 CAMDEN ST STE 102
SAN ANTONIO TX
78215-2003
US

IV. Provider business mailing address

311 CAMDEN ST STE 102
SAN ANTONIO TX
78215-2003
US

V. Phone/Fax

Practice location:
  • Phone: 210-281-9800
  • Fax: 210-281-1001
Mailing address:
  • Phone: 210-281-9800
  • Fax: 210-281-1001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberS6762
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: