Provider Demographics
NPI:1598911794
Name:IDIONG, MONDAY BASSEY (MANAGER)
Entity Type:Individual
Prefix:MR
First Name:MONDAY
Middle Name:BASSEY
Last Name:IDIONG
Suffix:
Gender:M
Credentials:MANAGER
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:9900 WESTPARK DR
Mailing Address - Street 2:SUITE 218
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77063-5277
Mailing Address - Country:US
Mailing Address - Phone:281-888-6139
Mailing Address - Fax:281-888-6168
Practice Address - Street 1:9900 WESTPARK DR
Practice Address - Street 2:SUITE 218
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77063-5277
Practice Address - Country:US
Practice Address - Phone:281-888-6139
Practice Address - Fax:281-888-6168
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-07
Last Update Date:2008-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0105272332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies