Provider Demographics
NPI:1417145558
Name:ONUNGWA, ONUNGWANTA
Entity Type:Individual
Prefix:MR
First Name:ONUNGWANTA
Middle Name:
Last Name:ONUNGWA
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 1:4402 BROADWAY BLVD
Mailing Address - Street 2:SUITE #7
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75043-8263
Mailing Address - Country:US
Mailing Address - Phone:214-703-0295
Mailing Address - Fax:214-703-0296
Practice Address - Street 1:4402 BROADWAY BLVD
Practice Address - Street 2:SUITE #7
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75043
Practice Address - Country:US
Practice Address - Phone:214-703-0295
Practice Address - Fax:214-703-0296
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-12
Last Update Date:2012-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX747142Medicare Oscar/Certification