Provider Demographics
NPI:1821272485
Name:NWAOGBO OPARA, EMMANUEL
Entity Type:Individual
Prefix:MR
First Name:EMMANUEL
Middle Name:
Last Name:NWAOGBO OPARA
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 1:20860 SAN SIMEON WAY
Mailing Address - Street 2:UNIT #102
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33179-1890
Mailing Address - Country:US
Mailing Address - Phone:305-624-7450
Mailing Address - Fax:305-623-7893
Practice Address - Street 1:1825 NW 167TH ST
Practice Address - Street 2:SUITE #102
Practice Address - City:MIAMI GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33056-4838
Practice Address - Country:US
Practice Address - Phone:305-624-7450
Practice Address - Fax:305-623-7893
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-19
Last Update Date:2007-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 7289101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMH 7289OtherLICENSE NUMBER