Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | M6813 | TX |
N | 208200000X | Surgeon | 41243 TEMPORARY | TX |
N | 208600000X | Surgeon | 41243 TEMPORARY | TX |
N | 2086S0102X | Surgical Critical Care | 41243 TEMP. | TX |
NPI | 1285731521 |
---|---|
Provider Name | Dr. Jackson Mosongo Ombaba |
First Address | El Paso, TX 79995-9520 |
Second Address | El Paso, TX 79905 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2006 |
Last Update Date | 25/03/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
178871301 | (05) | TX |
178871302 | CSHCN (01) | TX |
I38330 | (02) | TX |