Provider Demographics
NPI:1760658025
Name:ANAKWENZE, GERALD
Entity Type:Individual
Prefix:
First Name:GERALD
Middle Name:
Last Name:ANAKWENZE
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 1:11152 WESTHEIMER RD
Mailing Address - Street 2:#105
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77042-3208
Mailing Address - Country:US
Mailing Address - Phone:832-388-0187
Mailing Address - Fax:310-872-5317
Practice Address - Street 1:2122 RIDGEWORTH LN
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77469-6422
Practice Address - Country:US
Practice Address - Phone:832-388-0187
Practice Address - Fax:310-872-5317
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-06
Last Update Date:2010-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1000093171M00000X, 3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1000093OtherSTATE LICENCE