Provider Demographics
NPI:1821485731
Name:AHAGHOTU, EZENWANYI (ND)
Entity Type:Individual
Prefix:DR
First Name:EZENWANYI
Middle Name:
Last Name:AHAGHOTU
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2717 COMMERCIAL CENTER BLVD
Mailing Address - Street 2:SUITE E200
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-6410
Mailing Address - Country:US
Mailing Address - Phone:832-913-5022
Mailing Address - Fax:832-913-5101
Practice Address - Street 1:2717 COMMERCIAL CENTER BLVD
Practice Address - Street 2:SUITE E200
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494-6410
Practice Address - Country:US
Practice Address - Phone:832-913-5022
Practice Address - Fax:832-913-5101
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-17
Last Update Date:2015-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
133NN1002X
DCNP-0060175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education