Provider Demographics
NPI:1508618190
Name:ONUKWUBE, SOPURUCHUKWU IJEOMA
Entity Type:Individual
Prefix:
First Name:SOPURUCHUKWU
Middle Name:IJEOMA
Last Name:ONUKWUBE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7733 LOUIS PASTEUR DR APT 430
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3489
Mailing Address - Country:US
Mailing Address - Phone:281-965-0015
Mailing Address - Fax:
Practice Address - Street 1:3401 NORTH BLVD STE 200
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-3743
Practice Address - Country:US
Practice Address - Phone:225-381-6620
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-04
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program