Provider Demographics
NPI:1831441856
Name:ONGONGO, TAMARA ANDREA
Entity type:Individual
Prefix:MRS
First Name:TAMARA
Middle Name:ANDREA
Last Name:ONGONGO
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 1:4700 S KIRKWOOD RD
Mailing Address - Street 2:#1314
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77072-1246
Mailing Address - Country:US
Mailing Address - Phone:832-267-2028
Mailing Address - Fax:
Practice Address - Street 1:4700 S KIRKWOOD RD
Practice Address - Street 2:#1314
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77072-1246
Practice Address - Country:US
Practice Address - Phone:832-267-2028
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-15
Last Update Date:2012-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX175L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175L00000XOther Service ProvidersHomeopath