Healthcare Provider Details

I. General information

NPI: 1144508003
Provider Name (Legal Business Name): MRS. OLANIKE MARY OGUNTODU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2011
Last Update Date: 07/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2211 NORFOLK ST SUITE 505
HOUSTON TX
77098-4096
US

IV. Provider business mailing address

2211 NORFOLK ST SUITE 505
HOUSTON TX
77098-4096
US

V. Phone/Fax

Practice location:
  • Phone: 713-628-4452
  • Fax:
Mailing address:
  • Phone: 713-628-4452
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: