Provider Demographics
NPI:1447675616
Name:OBODOECHINA, RITA N
Entity type:Individual
Prefix:
First Name:RITA
Middle Name:N
Last Name:OBODOECHINA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10503 ROCKLEY RD
Mailing Address - Street 2:SUITE100
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77099-3553
Mailing Address - Country:US
Mailing Address - Phone:281-498-1554
Mailing Address - Fax:281-498-1554
Practice Address - Street 1:10503 ROCKLEY RD
Practice Address - Street 2:SUITE100
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77099-3553
Practice Address - Country:US
Practice Address - Phone:281-498-1554
Practice Address - Fax:281-498-1554
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-25
Last Update Date:2022-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
373H00000X
TX1457855355261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
No373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX261QA0600XMedicaid