Provider Demographics
NPI:1114408705
Name:OGBONNAYA, CLEOPATRA
Entity Type:Individual
Prefix:
First Name:CLEOPATRA
Middle Name:
Last Name:OGBONNAYA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6646 VILLARREAL DR
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77489-3535
Mailing Address - Country:US
Mailing Address - Phone:832-668-6899
Mailing Address - Fax:
Practice Address - Street 1:6646 VILLARREAL DR
Practice Address - Street 2:
Practice Address - City:MISSOURI CITY
Practice Address - State:TX
Practice Address - Zip Code:77489-3535
Practice Address - Country:US
Practice Address - Phone:832-668-6899
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-22
Last Update Date:2018-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX313493164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse