Provider Demographics
NPI:1215267836
Name:ODINAKACHUKWU AGU
Entity type:Organization
Organization Name:ODINAKACHUKWU AGU
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ODINAKACHUKWU
Authorized Official - Middle Name:
Authorized Official - Last Name:AGU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-305-1725
Mailing Address - Street 1:5103 SAXON HOLLOW CT
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77084-7577
Mailing Address - Country:US
Mailing Address - Phone:832-305-1725
Mailing Address - Fax:281-859-3014
Practice Address - Street 1:4315 LOCKWOOD DR
Practice Address - Street 2:SUITE NUMBER 7
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77026-4117
Practice Address - Country:US
Practice Address - Phone:832-305-1725
Practice Address - Fax:281-859-3014
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-04
Last Update Date:2010-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172V00000XOther Service ProvidersCommunity Health WorkerGroup - Multi-Specialty