Healthcare Provider Details

I. General information

NPI: 1225586704
Provider Name (Legal Business Name): TUNDE TOSIN OGUNGBEJA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2016
Last Update Date: 09/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

502 RITA LN APT B
ARLINGTON TX
76014-4577
US

IV. Provider business mailing address

502 RITA LANE, # B
ARLINGTON TX
76014
US

V. Phone/Fax

Practice location:
  • Phone: 214-228-3588
  • Fax: 817-549-2283
Mailing address:
  • Phone: 214-228-3588
  • Fax: 817-549-2283

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: