Healthcare Provider Details

I. General information

NPI: 1124031364
Provider Name (Legal Business Name): BRIAN OLOWUDE PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/15/2006
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

540 E BETTERAVIA RD STE D-118
SANTA MARIA CA
93454-8808
US

IV. Provider business mailing address

540 E BETTERAVIA RD STE D-118
SANTA MARIA CA
93454-8808
US

V. Phone/Fax

Practice location:
  • Phone: 805-242-1544
  • Fax:
Mailing address:
  • Phone: 805-242-1544
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number41388
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY19852
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: