Healthcare Provider Details

I. General information

NPI: 1154772986
Provider Name (Legal Business Name): OLUWATOBILOBA ODUNSI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2016
Last Update Date: 06/07/2026
Certification Date: 06/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CALIFORNIA ST STE 2300
SAN FRANCISCO CA
94111-5424
US

IV. Provider business mailing address

11330 LEGACY DR STE 103
FRISCO TX
75033-1210
US

V. Phone/Fax

Practice location:
  • Phone: 800-929-0926
  • Fax:
Mailing address:
  • Phone: 469-777-4691
  • Fax: 469-777-4542

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberLL39892
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberT5419
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number0101270017
License Number StateVA
# 4
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD61074008
License Number StateWA
# 5
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA-184387
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: