Healthcare Provider Details

I. General information

NPI: 1417830654
Provider Name (Legal Business Name): MAYOWA OBAFEMI RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2025
Last Update Date: 07/28/2025
Certification Date: 07/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13802 MARTINGALE POINTE DR
CYPRESS TX
77433-8394
US

IV. Provider business mailing address

13802 MARTINGALE POINTE DR
CYPRESS TX
77433-8394
US

V. Phone/Fax

Practice location:
  • Phone: 713-839-6554
  • Fax:
Mailing address:
  • Phone: 713-839-6554
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1067653
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: