Provider Demographics
NPI:1558822403
Name:NGODO, DAMIAN SUNDAY
Entity Type:Individual
Prefix:
First Name:DAMIAN
Middle Name:SUNDAY
Last Name:NGODO
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 1:12519 MAGNOLIA CYN
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77099-6411
Mailing Address - Country:US
Mailing Address - Phone:713-820-8515
Mailing Address - Fax:
Practice Address - Street 1:UNM HEALTH SYSTEM 1 UNIVERSITY OF NM
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87131-2178
Practice Address - Country:US
Practice Address - Phone:713-820-8515
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-25
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA204999363LP0808X
TXAP139601363LP0808X
NM56993363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty