Provider Demographics
NPI:1093138497
Name:OZOMMA-RAFUA, THERESA U
Entity type:Individual
Prefix:MS
First Name:THERESA
Middle Name:U
Last Name:OZOMMA-RAFUA
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 1:2100 E TREMONT AVE APT 3C
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10462-5737
Mailing Address - Country:US
Mailing Address - Phone:718-536-7244
Mailing Address - Fax:
Practice Address - Street 1:2275 COLEMAN STREET,
Practice Address - Street 2:SUIT 4/LOWER PARKING LOT LEVEL
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234
Practice Address - Country:US
Practice Address - Phone:718-615-0049
Practice Address - Fax:866-845-3415
Is Sole Proprietor?:No
Enumeration Date:2014-01-22
Last Update Date:2014-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY503299-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse