Organization
IMMACULATE VASCULAR ACCESS CENTER PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NGOZI OKOBA MD (OWNER)
(240) 837-3293
Entity
Organization
Contact information
Practice address
349 S HELEN MOORE RD APT 6205, SAN BENITO, TX 78586-9091
(240) 837-3293
Mailing address
349 S HELEN MOORE RD APT 6205, SAN BENITO, TX 78586-9091
(240) 837-3293
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
—
—
Other
Enumeration date
10/11/2019
Last updated
10/11/2019
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