Provider Demographics
NPI:1043804487
Name:JON-UBABUCO, CHIJI NDU (NP)
Entity Type:Individual
Prefix:
First Name:CHIJI
Middle Name:NDU
Last Name:JON-UBABUCO
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2029 W BEAUREGARD AVE
Mailing Address - Street 2:
Mailing Address - City:SAN ANGELO
Mailing Address - State:TX
Mailing Address - Zip Code:76901-3812
Mailing Address - Country:US
Mailing Address - Phone:325-947-5605
Mailing Address - Fax:325-223-1480
Practice Address - Street 1:1610 S CHADBOURNE ST
Practice Address - Street 2:
Practice Address - City:SAN ANGELO
Practice Address - State:TX
Practice Address - Zip Code:76903-8510
Practice Address - Country:US
Practice Address - Phone:325-658-5339
Practice Address - Fax:325-223-1480
Is Sole Proprietor?:No
Enumeration Date:2021-02-25
Last Update Date:2021-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1026299363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health