Healthcare Provider Details

I. General information

NPI: 1154291524
Provider Name (Legal Business Name): TOLULOPE DAVID OLOWOKERE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/10/2025
Last Update Date: 11/10/2025
Certification Date: 11/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11240 FM 1960 RD W STE 209
HOUSTON TX
77065-3664
US

IV. Provider business mailing address

11240 FM 1960 RD W STE 209
HOUSTON TX
77065-3664
US

V. Phone/Fax

Practice location:
  • Phone: 877-418-2978
  • Fax:
Mailing address:
  • Phone: 877-418-2978
  • Fax: 866-500-2186

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: