Provider Demographics
NPI:1649501958
Name:AKALONU, THEODORE AMANZE
Entity type:Individual
Prefix:
First Name:THEODORE
Middle Name:AMANZE
Last Name:AKALONU
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 1:20026 PEMETIC TRL
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77407-5367
Mailing Address - Country:US
Mailing Address - Phone:713-530-4326
Mailing Address - Fax:281-733-2132
Practice Address - Street 1:20026 PEMETIC TRL
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77407-5367
Practice Address - Country:US
Practice Address - Phone:713-530-4326
Practice Address - Fax:281-733-2132
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-26
Last Update Date:2010-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10003723416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX271226953OtherEIN