Healthcare Provider Details

I. General information

NPI: 1144578733
Provider Name (Legal Business Name): OLUSOLA FRANCISCA OMOOLAYE-ONOVIRAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: OLUSOLA FRANCISCA OMOOLAYE MD

II. Dates (important events)

Enumeration Date: 08/29/2012
Last Update Date: 04/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 UNIVERSITY BLVD
GALVESTON TX
77555-0567
US

IV. Provider business mailing address

301 UNIVERSITY BLVD
GALVESTON TX
77555-0567
US

V. Phone/Fax

Practice location:
  • Phone: 832-505-2100
  • Fax: 281-337-0704
Mailing address:
  • Phone: 832-505-2100
  • Fax: 281-337-0704

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License NumberBP10052132
License Number StateTX
# 2
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: