Healthcare Provider Details

I. General information

NPI: 1598569055
Provider Name (Legal Business Name): GLORIA IFEOLUWA OGUNLADE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2025
Last Update Date: 04/03/2025
Certification Date: 03/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

OUR LADY OF THE ANGELS HOSPITAL, 420 AVENUE F
BOGALUSA LA
70427
US

IV. Provider business mailing address

211 LIBERTY AVE APT 1234
LAFAYETTE LA
70508-6871
US

V. Phone/Fax

Practice location:
  • Phone: 985-730-6970
  • Fax:
Mailing address:
  • Phone: 240-781-9081
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: