Provider Demographics
NPI:1427898667
Name:MOCHABO, EVANS NTENGA
Entity type:Individual
Prefix:
First Name:EVANS
Middle Name:NTENGA
Last Name:MOCHABO
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 1:2363 AMBASSADOR CT
Mailing Address - Street 2:
Mailing Address - City:HEATH
Mailing Address - State:TX
Mailing Address - Zip Code:75126-1687
Mailing Address - Country:US
Mailing Address - Phone:972-693-6228
Mailing Address - Fax:
Practice Address - Street 1:2363 AMBASSADOR CT
Practice Address - Street 2:
Practice Address - City:HEATH
Practice Address - State:TX
Practice Address - Zip Code:75126-1687
Practice Address - Country:US
Practice Address - Phone:972-693-6228
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-27
Last Update Date:2024-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1161912363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health