Provider Demographics
NPI:1487910618
Name:IZU, GODWIN ONOS
Entity type:Individual
Prefix:
First Name:GODWIN
Middle Name:ONOS
Last Name:IZU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4801 N CLASSEN BLVD
Mailing Address - Street 2:SUITE 159
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73118-4627
Mailing Address - Country:US
Mailing Address - Phone:405-607-6670
Mailing Address - Fax:405-607-6671
Practice Address - Street 1:4801 N CLASSEN BLVD
Practice Address - Street 2:SUITE 159
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73118-4627
Practice Address - Country:US
Practice Address - Phone:405-607-6670
Practice Address - Fax:405-607-6671
Is Sole Proprietor?:No
Enumeration Date:2012-04-02
Last Update Date:2013-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitation