Individual
PATRICK ANAYO MONEKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
7268 PORTILLO, GRAND PRAIRIE, TX 75054-0073
(817) 366-0950
Mailing address
7268 PORTILLO, GRAND PRAIRIE, TX 75054-0073
(817) 366-0950
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3589731
—
TX
Enumeration date
05/07/2018
Last updated
05/07/2018
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