Healthcare Provider Details

I. General information

NPI: 1952097511
Provider Name (Legal Business Name): OLAOLUWA OGUNNOWO DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/17/2023
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 N WILMOT RD
TUCSON AZ
85711-2602
US

IV. Provider business mailing address

350 N WILMOT RD
TUCSON AZ
85711-2602
US

V. Phone/Fax

Practice location:
  • Phone: 914-798-8971
  • Fax:
Mailing address:
  • Phone: 520-873-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number012243
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: