Provider Demographics
NPI:1790566313
Name:ASHIBUOGWU, ZELINJOH MUMBI
Entity Type:Individual
Prefix:MR
First Name:ZELINJOH
Middle Name:MUMBI
Last Name:ASHIBUOGWU
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 1:1908 GETTYSBURG PL
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76022-7668
Mailing Address - Country:US
Mailing Address - Phone:972-333-7643
Mailing Address - Fax:817-786-8543
Practice Address - Street 1:405 AIRPORT FWY # 505
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76021-5358
Practice Address - Country:US
Practice Address - Phone:678-849-4978
Practice Address - Fax:817-786-8543
Is Sole Proprietor?:No
Enumeration Date:2023-10-10
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX23795293172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver