Provider Demographics
NPI:1154808178
Name:OGINDO, JACK AMAYO JR
Entity type:Individual
Prefix:
First Name:JACK
Middle Name:AMAYO
Last Name:OGINDO
Suffix:JR
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 1:8403 BRIGHTON LAKE LN
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77095-4761
Mailing Address - Country:US
Mailing Address - Phone:281-871-1940
Mailing Address - Fax:713-583-5660
Practice Address - Street 1:14950 HEATHROW FOREST PARKWAY
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77032
Practice Address - Country:US
Practice Address - Phone:281-921-2301
Practice Address - Fax:281-921-2305
Is Sole Proprietor?:No
Enumeration Date:2018-07-23
Last Update Date:2018-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX229119164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse