Healthcare Provider Details

I. General information

NPI: 1083471866
Provider Name (Legal Business Name): ADEBAMIDELE OLUFEM OGUNLADE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2024
Last Update Date: 02/28/2024
Certification Date: 02/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7517 COBAL CANYON LN
LAS VEGAS NV
89129-2903
US

IV. Provider business mailing address

7517 COBAL CANYON LN
LAS VEGAS NV
89129-2903
US

V. Phone/Fax

Practice location:
  • Phone: 702-339-0356
  • Fax:
Mailing address:
  • Phone: 702-339-0356
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: