MEDICARE: DR. EZENWANYI AHAGHOTU N.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133NN1002X	Nutrition Education Nutritionist
2	175F00000X	Naturopath	NP-0060	DC

General Provider Information

NPI Number	:	1821485731
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EZENWANYI AHAGHOTU N.D.

Provider Business Mailing Address
First Line	:	2717 COMMERCIAL CENTER BLVD
Second Line	:	SUITE E200
City	:	KATY
State	:	TX
Zip	:	77494-6410
Country	:	US
Telephone Number	:	832-913-5022
Fax Number	:	832-913-5101

Provider Business Practice Location Address
First Line	:	2717 COMMERCIAL CENTER BLVD
Second Line	:	SUITE E200
City	:	KATY
State	:	TX
Zip	:	77494-6410
Country	:	US
Telephone Number	:	832-913-5022
Fax Number	:	832-913-5101

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/17/2015
Last Update Date	:	08/25/2015

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