Healthcare Provider Details

I. General information

NPI: 1467224485
Provider Name (Legal Business Name): ALABA OLOGUNTOYE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/24/2023
Last Update Date: 10/24/2023
Certification Date: 10/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1723 HIGHWOOD RD
FORNEY TX
75126-7784
US

IV. Provider business mailing address

1723 HIGHWOOD RD
FORNEY TX
75126-7784
US

V. Phone/Fax

Practice location:
  • Phone: 903-917-4233
  • Fax:
Mailing address:
  • Phone: 903-917-4233
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1022919
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: