Provider Demographics
NPI:1174658389
Name:OGBONNA, CLETUS CHIKEZIE
Entity Type:Individual
Prefix:MR
First Name:CLETUS
Middle Name:CHIKEZIE
Last Name:OGBONNA
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 1:11103 SAN PEDRO AVE
Mailing Address - Street 2:STE 238
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78216-3122
Mailing Address - Country:US
Mailing Address - Phone:210-308-5511
Mailing Address - Fax:210-308-5522
Practice Address - Street 1:11103 SAN PEDRO AVE
Practice Address - Street 2:STE 238
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78216-3122
Practice Address - Country:US
Practice Address - Phone:210-308-5511
Practice Address - Fax:210-308-5522
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX738277163W00000X
374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163W00000XNursing Service ProvidersRegistered Nurse
Not Answered374U00000XNursing Service Related ProvidersHome Health Aide