Healthcare Provider Details

I. General information

NPI: 1497255020
Provider Name (Legal Business Name): MRS. OLAWUNMI OMOTAYO OLONIYO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2018
Last Update Date: 02/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14785 PRESTON RD STE 550
DALLAS TX
75254-7899
US

IV. Provider business mailing address

14785 PRESTON RD STE 550
DALLAS TX
75254-7899
US

V. Phone/Fax

Practice location:
  • Phone: 469-407-3491
  • Fax: 972-836-9749
Mailing address:
  • Phone: 469-407-3491
  • Fax: 972-836-9749

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: