Provider Demographics
NPI:1508552399
Name:BAKINA, ABENI
Entity Type:Individual
Prefix:
First Name:ABENI
Middle Name:
Last Name:BAKINA
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 1:1700 FAIRFIELD PKWY UNIT 7204
Mailing Address - Street 2:
Mailing Address - City:BURLESON
Mailing Address - State:TX
Mailing Address - Zip Code:76028-3383
Mailing Address - Country:US
Mailing Address - Phone:682-444-6193
Mailing Address - Fax:
Practice Address - Street 1:1700 FAIRFIELD PKWY UNIT 7204
Practice Address - Street 2:
Practice Address - City:BURLESON
Practice Address - State:TX
Practice Address - Zip Code:76028-3383
Practice Address - Country:US
Practice Address - Phone:682-444-6193
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-13
Last Update Date:2023-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver