Immaculate Vascular Access Center PLLC

Primary specialty

Nephrology PhysicianTaxonomy code 207RN0300X

Legal business name

IMMACULATE VASCULAR ACCESS CENTER PLLC

Practice address

349 S Helen Moore Rd Apt 6205
San Benito, TX 78586-9091

Phone

(240) 837-3293

NPI assigned

Oct 11, 2019

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ngozi Okoba, MD

Title

Owner

Phone

(240) 837-3293

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1570752000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1570752000000",
    "number": "1639711534",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "349 S HELEN MOORE RD APT 6205",
            "city": "SAN BENITO",
            "state": "TX",
            "postal_code": "785869091",
            "telephone_number": "240-837-3293"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "349 S HELEN MOORE RD APT 6205",
            "city": "SAN BENITO",
            "state": "TX",
            "postal_code": "785869091",
            "telephone_number": "240-837-3293"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IMMACULATE VASCULAR ACCESS CENTER PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-10-11",
        "last_updated": "2019-10-11",
        "status": "A",
        "authorized_official_last_name": "OKOBA",
        "authorized_official_first_name": "NGOZI",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "240-837-3293",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Nephrology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Nephrology Physician in San Benito, TX
• Providers in San Benito, TX by specialty
• Nephrology Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 11, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.