Individual
DR. JACKSON MOSONGO OMBABA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4801 ALBERTA AVE, EL PASO, TX 79905
(915) 545-7507
(915) 545-9799
Mailing address
PO BOX 9520, EL PASO, TX 79995-9520
(915) 545-9795
(915) 545-9799
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
M6813
TX
208600000X
Surgery Physician
41243 TEMPORARY
TX
2086S0102X
Surgical Critical Care Physician
41243 TEMP.
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
178871301
—
TX
01
—
178871302
CSHCN
TX
Enumeration date
09/20/2006
Last updated
03/25/2019
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