Provider Demographics
NPI:1811384183
Name:OTERI, UFUOMA
Entity type:Individual
Prefix:
First Name:UFUOMA
Middle Name:
Last Name:OTERI
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 1:14923 SAWTOOTH OAK DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77082-2983
Mailing Address - Country:US
Mailing Address - Phone:646-515-6528
Mailing Address - Fax:
Practice Address - Street 1:14923 SAWTOOTH OAK DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77082-2983
Practice Address - Country:US
Practice Address - Phone:646-515-6528
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-23
Last Update Date:2015-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP127090281P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes281P00000XHospitalsChronic Disease Hospital