Healthcare Provider Details

I. General information

NPI: 1487028619
Provider Name (Legal Business Name): RASAQ ADENIYI KOTUN TRANSPORTATION PROVI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/27/2015
Last Update Date: 11/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2611 CYPRESS CREEK PKWY F-102
HOUSTON TX
77068-3731
US

IV. Provider business mailing address

2611 CYPRESS CREEK PKWY F-102
HOUSTON TX
77068-3731
US

V. Phone/Fax

Practice location:
  • Phone: 713-875-9776
  • Fax: 281-973-0970
Mailing address:
  • Phone: 713-875-9776
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License Number14373015
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: