Basic Information
Provider Information | |||||||||
NPI: | 1881048379 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | NGOMBA | ||||||||
FirstName: | VALMY | ||||||||
MiddleName: | EFFETY | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 20619 FERTILE VALLEY LN DEPT OF | ||||||||
Address2: |   | ||||||||
City: | RICHMOND | ||||||||
State: | TX | ||||||||
PostalCode: | 774071042 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7134198022 | ||||||||
FaxNumber: | 7188183225 | ||||||||
Practice Location | |||||||||
Address1: | 18951 N MEMORIAL DR | ||||||||
Address2: |   | ||||||||
City: | HUMBLE | ||||||||
State: | TX | ||||||||
PostalCode: | 773384217 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2815407700 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 04/20/2016 | ||||||||
LastUpdateDate: | 09/27/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 09/27/2022 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | S2129 | TX | Y |   | Allopathic & Osteopathic Physicians | Internal Medicine |   |
No ID Information.