Provider Demographics
NPI:1033536065
Name:OSUAGWU, DANIEL
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:OSUAGWU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10103 FONDREN RD
Mailing Address - Street 2:SUIT #460
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77096-4556
Mailing Address - Country:US
Mailing Address - Phone:713-773-1066
Mailing Address - Fax:713-773-0445
Practice Address - Street 1:10103 FONDREN RD
Practice Address - Street 2:SUIT #460
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77096-4556
Practice Address - Country:US
Practice Address - Phone:713-773-1066
Practice Address - Fax:713-773-0445
Is Sole Proprietor?:No
Enumeration Date:2014-03-27
Last Update Date:2014-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0006749103TM1800X
TX0067493747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1871628701Medicaid