Provider Demographics
NPI:1942593736
Name:CLETUS ONYIORAH, M.D., P.A.
Entity Type:Organization
Organization Name:CLETUS ONYIORAH, M.D., P.A.
Other - Org Name:ABC PEDIATRICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CLETUS
Authorized Official - Middle Name:
Authorized Official - Last Name:ONYIORAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:956-287-6106
Mailing Address - Street 1:7402 N 16TH LN
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504-3244
Mailing Address - Country:US
Mailing Address - Phone:956-287-6106
Mailing Address - Fax:956-287-6109
Practice Address - Street 1:604 SOUTH JACKSON ROAD
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539
Practice Address - Country:US
Practice Address - Phone:956-287-6106
Practice Address - Fax:956-287-6109
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-26
Last Update Date:2011-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN1035261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX200621506Medicaid