Provider Demographics
NPI:1376039180
Name:EZEMBA, VICTOR C
Entity type:Individual
Prefix:
First Name:VICTOR
Middle Name:C
Last Name:EZEMBA
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 1:6922 ADDICKS CLODINE RD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77083-1102
Mailing Address - Country:US
Mailing Address - Phone:713-922-7303
Mailing Address - Fax:832-295-3800
Practice Address - Street 1:6922 ADDICKS CLODINE RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77083-1102
Practice Address - Country:US
Practice Address - Phone:713-922-7303
Practice Address - Fax:832-295-3800
Is Sole Proprietor?:No
Enumeration Date:2018-07-04
Last Update Date:2018-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX155512471C3401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471C3401XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistComputed Tomography