1710296736 NPI number — CECILIA OKAFOR DO PA

Table of content: (NPI 1710296736)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710296736 NPI number — CECILIA OKAFOR DO PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CECILIA OKAFOR DO PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1710296736
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/27/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1143 S BUCKNER BLVD STE 144
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75217-4304
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
214-398-0398
Provider Business Mailing Address Fax Number:
214-398-7200

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
204 LAURA LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GRAND PRAIRIE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75052-2803
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-325-2002
Provider Business Practice Location Address Fax Number:
972-642-5741
Provider Enumeration Date:
09/27/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
OKAFOR
Authorized Official First Name:
CECILIA
Authorized Official Middle Name:
NNENNA
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
214-398-0398

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)