Healthcare Provider Details

I. General information

NPI: 1982385514
Provider Name (Legal Business Name): BUKOLA BANKOLE OGUNJOBI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2023
Last Update Date: 07/27/2023
Certification Date: 07/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1326 CRESS GARDEN LN
FORNEY TX
75126-3756
US

IV. Provider business mailing address

1326 CRESS GARDEN LN
FORNEY TX
75126-3756
US

V. Phone/Fax

Practice location:
  • Phone: 240-702-4667
  • Fax:
Mailing address:
  • Phone: 240-702-4667
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: