Provider Demographics
NPI:1467259903
Name:UGWUNZE, CHISOM FAITH (RD, LD)
Entity type:Individual
Prefix:
First Name:CHISOM
Middle Name:FAITH
Last Name:UGWUNZE
Suffix:
Gender:
Credentials:RD, LD
Other - Prefix:
Other - First Name:CHISOM
Other - Middle Name:FAITH
Other - Last Name:ETUMNU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2510 S LOOP 336 W STE 215B
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77304-3737
Mailing Address - Country:US
Mailing Address - Phone:936-596-0445
Mailing Address - Fax:
Practice Address - Street 1:2510 S LOOP 336 W STE 215B
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304-3737
Practice Address - Country:US
Practice Address - Phone:936-596-0445
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-03
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT85725133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered