Healthcare Provider Details

I. General information

NPI: 1902594708
Provider Name (Legal Business Name): TEMITOPE JOYCE OGUNDIPE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TEMITOPE JOYCE DAVID MD

II. Dates (important events)

Enumeration Date: 04/28/2023
Last Update Date: 04/28/2023
Certification Date: 04/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3533 S ALAMEDA ST
CORPUS CHRISTI TX
78411-1721
US

IV. Provider business mailing address

2235 CONQUEST WAY
ODENTON MD
21113-2679
US

V. Phone/Fax

Practice location:
  • Phone: 361-694-5465
  • Fax:
Mailing address:
  • Phone: 443-712-3859
  • 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: