Provider Demographics
NPI:1114770690
Name:OGAMBA, KENEOLISA ERIC (MD)
Entity Type:Individual
Prefix:DR
First Name:KENEOLISA
Middle Name:ERIC
Last Name:OGAMBA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:6431 FANNIN ST RM 5.170
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-1501
Mailing Address - Country:US
Mailing Address - Phone:713-500-6113
Mailing Address - Fax:713-500-0648
Practice Address - Street 1:6431 FANNIN ST RM 5.170
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-1501
Practice Address - Country:US
Practice Address - Phone:713-500-6113
Practice Address - Fax:713-500-0648
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-08
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer