Provider Demographics
NPI:1144787185
Name:MOGAKA, FELIX OTISO
Entity Type:Individual
Prefix:
First Name:FELIX
Middle Name:OTISO
Last Name:MOGAKA
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 1:2515 QUAIL RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:MELISSA
Mailing Address - State:TX
Mailing Address - Zip Code:75454-2124
Mailing Address - Country:US
Mailing Address - Phone:432-271-6764
Mailing Address - Fax:
Practice Address - Street 1:2515 QUAIL RIDGE RD
Practice Address - Street 2:
Practice Address - City:MELISSA
Practice Address - State:TX
Practice Address - Zip Code:75454-2124
Practice Address - Country:US
Practice Address - Phone:432-271-6764
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-26
Last Update Date:2019-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX922505163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse