Provider Demographics
NPI:1790586139
Name:EBIZUGBE, MERIT
Entity type:Individual
Prefix:
First Name:MERIT
Middle Name:
Last Name:EBIZUGBE
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:619 ROUND LAKE DR
Mailing Address - Street 2:
Mailing Address - City:ROSENBERG
Mailing Address - State:TX
Mailing Address - Zip Code:77469-2548
Mailing Address - Country:US
Mailing Address - Phone:832-616-6130
Mailing Address - Fax:
Practice Address - Street 1:619 ROUND LAKE DR
Practice Address - Street 2:
Practice Address - City:ROSENBERG
Practice Address - State:TX
Practice Address - Zip Code:77469-2548
Practice Address - Country:US
Practice Address - Phone:832-616-6130
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-21
Last Update Date:2025-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX49307395343900000X
347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)