Provider Demographics
NPI:1386878387
Name:CAROLINE NJERI MBOGUA MD
Entity type:Organization
Organization Name:CAROLINE NJERI MBOGUA MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CAROLINE
Authorized Official - Middle Name:NJERI
Authorized Official - Last Name:MBOGUA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-741-2299
Mailing Address - Street 1:1213 HERMANN DR
Mailing Address - Street 2:445 PARK PLAZA PROFESSIONAL BLDG
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77004-7018
Mailing Address - Country:US
Mailing Address - Phone:713-741-2299
Mailing Address - Fax:713-747-3583
Practice Address - Street 1:1213 HERMANN DR
Practice Address - Street 2:445 PARK PLAZA PROFESSIONAL BLDG
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77004-7018
Practice Address - Country:US
Practice Address - Phone:713-741-2299
Practice Address - Fax:713-747-3583
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-06
Last Update Date:2009-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ0775207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2189244OtherAETNA
TX136461406Medicaid
TXF29677Medicare UPIN
TX136461406Medicaid