Healthcare Provider Details

I. General information

NPI: 1952807463
Provider Name (Legal Business Name): TOLULOPE OLASUNKANMI AMIOLA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2018
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 BARTLETT DR STE 102
EL PASO TX
79912-1607
US

IV. Provider business mailing address

211 BARTLETT DR STE 102
EL PASO TX
79912-1607
US

V. Phone/Fax

Practice location:
  • Phone: 240-706-2619
  • Fax:
Mailing address:
  • Phone: 240-706-2619
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberE-17746
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberV6854
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberV4874
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number0101275503
License Number StateVA
# 5
Primary TaxonomyN
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: