Provider Demographics
NPI:1285120386
Name:CHUKWUEMEKA, MOORE MOSES
Entity type:Individual
Prefix:
First Name:MOORE
Middle Name:MOSES
Last Name:CHUKWUEMEKA
Suffix:
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 1:11152 WESTHEIMER RD # 848
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77042-3208
Mailing Address - Country:US
Mailing Address - Phone:713-808-5534
Mailing Address - Fax:
Practice Address - Street 1:11152 WESTHEIMER RD # 848
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77042-3208
Practice Address - Country:US
Practice Address - Phone:713-808-5534
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-02
Last Update Date:2018-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health