Provider Demographics
NPI:1336343375
Name:ABANAKA, JOSEPH NGOZI
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:NGOZI
Last Name:ABANAKA
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 1:937 SYLVAN CREEK DR
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75067-4233
Mailing Address - Country:US
Mailing Address - Phone:972-221-2775
Mailing Address - Fax:972-221-2775
Practice Address - Street 1:937 SYLVAN CREEK DR
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75067-4233
Practice Address - Country:US
Practice Address - Phone:972-221-2775
Practice Address - Fax:972-221-2775
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program