Provider Demographics
NPI:1770263675
Name:AGBARA, CHIDIEBERE J
Entity type:Individual
Prefix:MISS
First Name:CHIDIEBERE
Middle Name:J
Last Name:AGBARA
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 1:6002 SOLEDAD PINE CIR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77407-1045
Mailing Address - Country:US
Mailing Address - Phone:832-495-1315
Mailing Address - Fax:
Practice Address - Street 1:6002 SOLEDAD PINE CIR
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77407-1045
Practice Address - Country:US
Practice Address - Phone:832-495-1315
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-25
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide