Provider Demographics
NPI:1902385966
Name:EKHOMU, BECKY JUSTINA
Entity Type:Individual
Prefix:
First Name:BECKY
Middle Name:JUSTINA
Last Name:EKHOMU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4041 MEDICAL DR APT 1302
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-2122
Mailing Address - Country:US
Mailing Address - Phone:210-505-0545
Mailing Address - Fax:
Practice Address - Street 1:5726 W HAUSMAN RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78249-1650
Practice Address - Country:US
Practice Address - Phone:210-349-7030
Practice Address - Fax:210-349-0097
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-10
Last Update Date:2018-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX774035163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health