Provider Demographics
NPI:1154612943
Name:OZCELIK, BENA ELLICKALPUTHENPURA (PA-C)
Entity type:Individual
Prefix:
First Name:BENA
Middle Name:ELLICKALPUTHENPURA
Last Name:OZCELIK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:BENA
Other - Middle Name:ELIZABETH
Other - Last Name:ELLICKALPUTHENPURA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:P O BOX 4439
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77210-4439
Mailing Address - Country:US
Mailing Address - Phone:713-792-2991
Mailing Address - Fax:
Practice Address - Street 1:1515 HOLCOMBE BLVD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-4009
Practice Address - Country:US
Practice Address - Phone:713-792-6161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-27
Last Update Date:2020-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA06611363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX284078701Medicaid
TX850N39OtherBCBS
TX284078701Medicaid