Provider Demographics
NPI:1710220272
Name:ODUNUGA, FIDEL O
Entity Type:Individual
Prefix:
First Name:FIDEL
Middle Name:O
Last Name:ODUNUGA
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 1:4739 CAIRNVILLAGE ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77084-2553
Mailing Address - Country:US
Mailing Address - Phone:832-465-7745
Mailing Address - Fax:
Practice Address - Street 1:4739 CAIRNVILLAGE ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77084-2553
Practice Address - Country:US
Practice Address - Phone:832-465-7745
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-03
Last Update Date:2013-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program