Provider Demographics
NPI:1629496641
Name:ORIAIFO, AMENZE ANGEL (MD)
Entity Type:Individual
Prefix:
First Name:AMENZE
Middle Name:ANGEL
Last Name:ORIAIFO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:AMENZE
Other - Middle Name:ANGEL
Other - Last Name:OSA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5717 BALCONES DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731-4203
Mailing Address - Country:US
Mailing Address - Phone:512-327-7000
Mailing Address - Fax:512-314-1662
Practice Address - Street 1:1700 S MOPAC EXPY
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78746-7572
Practice Address - Country:US
Practice Address - Phone:512-327-7000
Practice Address - Fax:512-327-5200
Is Sole Proprietor?:No
Enumeration Date:2014-04-07
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TXR6253207WX0009X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0009XAllopathic & Osteopathic PhysiciansOphthalmologyGlaucoma Specialist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology