Provider Demographics
NPI:1679595441
Name:OZIGBO, IJEOMA FLORENCE (RPA-C)
Entity type:Individual
Prefix:MRS
First Name:IJEOMA
Middle Name:FLORENCE
Last Name:OZIGBO
Suffix:
Gender:F
Credentials:RPA-C
Other - Prefix:
Other - First Name:IJEOMA
Other - Middle Name:FLORENCE
Other - Last Name:MADU
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA
Mailing Address - Street 1:12030 BANDERA RD STE 128
Mailing Address - Street 2:
Mailing Address - City:HELOTES
Mailing Address - State:TX
Mailing Address - Zip Code:78023-4776
Mailing Address - Country:US
Mailing Address - Phone:210-473-4211
Mailing Address - Fax:877-453-5811
Practice Address - Street 1:12030 BANDERA RD STE 128
Practice Address - Street 2:
Practice Address - City:HELOTES
Practice Address - State:TX
Practice Address - Zip Code:78023-4776
Practice Address - Country:US
Practice Address - Phone:121-047-3421
Practice Address - Fax:877-453-5811
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2023-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA04579363A00000X
NY008110363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q44448Medicare UPIN
NY5846L1Medicare ID - Type Unspecified