=====================================================
General NPI Number Information
=====================================================
NPI Number | 1134968985
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | REHOBOTH WELLNESS CENTER PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/22/2024
-----------------------------------------------------
Last Update Date | 11/25/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 440 COBIA DR STE 701
-----------------------------------------------------
City | KATY
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77494-6892
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 240-955-9528
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 440 COBIA DR STE 701
-----------------------------------------------------
City | KATY
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77494-6892
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 240-255-9528
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DOCTOR OF NURSE PRACTITIONER
-----------------------------------------------------
Name | DR. CHIBUZO EFURIBE
-----------------------------------------------------
Credential | DNP, FNP, PMHNP
-----------------------------------------------------
Telephone | 240-255-9528
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2300X
-----------------------------------------------------
Taxonomy Name | Primary Care Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 261QM0801X
-----------------------------------------------------
Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------