Healthcare Provider Details

I. General information

NPI: 1023631884
Provider Name (Legal Business Name): SIYA OLOSO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2020
Last Update Date: 03/01/2021
Certification Date: 03/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9725 HOMESTEAD RD
HOUSTON TX
77016-4403
US

IV. Provider business mailing address

11627 CURATE WIND CT
RICHMOND TX
77407-2255
US

V. Phone/Fax

Practice location:
  • Phone: 713-829-7595
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number889198
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1021028
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: