Healthcare Provider Details

I. General information

NPI: 1235314451
Provider Name (Legal Business Name): MR. TAJUDEEN KOLAWOLE OGUNYOKU
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/07/2008
Last Update Date: 01/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11555 BISSONNET ST SUITE 1015
HOUSTON TX
77099-5500
US

IV. Provider business mailing address

11555 BISSONNET ST P.O.BOX 720843
HOUSTON TX
77099-5500
US

V. Phone/Fax

Practice location:
  • Phone: 713-448-9670
  • Fax:
Mailing address:
  • Phone: 832-681-0013
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License Number
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: