Provider Demographics
NPI:1194335240
Name:MBUAGBAW, EBIKA EYONG
Entity type:Individual
Prefix:MRS
First Name:EBIKA
Middle Name:EYONG
Last Name:MBUAGBAW
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 1:13623 ELDRIDGE SPRINGS WAY
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77083-6538
Mailing Address - Country:US
Mailing Address - Phone:165-167-5731
Mailing Address - Fax:
Practice Address - Street 1:1420 FM 1960 BYPASS RD E STE 116
Practice Address - Street 2:
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77338-3934
Practice Address - Country:US
Practice Address - Phone:713-457-4372
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-04
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP145966363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health