Provider Demographics
NPI:1316946734
Name:NDUKA, CHINWE CELESTINA (MD)
Entity type:Individual
Prefix:
First Name:CHINWE
Middle Name:CELESTINA
Last Name:NDUKA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 W HAGUE RD STE 140
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79902-5811
Mailing Address - Country:US
Mailing Address - Phone:915-774-0458
Mailing Address - Fax:915-774-0027
Practice Address - Street 1:125 W HAGUE RD STE 140
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-5811
Practice Address - Country:US
Practice Address - Phone:915-774-0458
Practice Address - Fax:915-774-0027
Is Sole Proprietor?:No
Enumeration Date:2005-07-18
Last Update Date:2019-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK6182207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX147436301Medicaid
8004B0Medicare PIN