MEDICARE: CHIKA GALEGA-SABUM

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	16221	TX
2	163W00000X	Registered Nurse	978326	TX
3	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	1163297	TX

General Provider Information

NPI Number	:	1861122103
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHIKA GALEGA-SABUM

Provider Business Mailing Address
First Line	:	4322 HERRIDGE ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77022-3945
Country	:	US
Telephone Number	:	763-445-1079
Fax Number	:	832-225-3911

Provider Business Practice Location Address
First Line	:	4322 HERRIDGE ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77022-3945
Country	:	US
Telephone Number	:	346-857-4883
Fax Number	:

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

Provider Enumeration Date	:	06/10/2022
Last Update Date	:	11/06/2024

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