Healthcare Provider Details

I. General information

NPI: 1821651910
Provider Name (Legal Business Name): AIMEBENOMON OMOYE IDAHOSA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/15/2019
Last Update Date: 10/08/2025
Certification Date: 10/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2443 FILLMORE ST # 38015799
SAN FRANCISCO CA
94115-1814
US

IV. Provider business mailing address

1122 W 16TH ST UNIT F
HOUSTON TX
77008-4785
US

V. Phone/Fax

Practice location:
  • Phone: 165-086-5517
  • Fax: 165-035-2522
Mailing address:
  • Phone: 317-702-8812
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083B0002X
TaxonomyObesity Medicine (Preventive Medicine) Physician
License NumberT5926
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberT5926
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: