Healthcare Provider Details

I. General information

NPI: 1760125751
Provider Name (Legal Business Name): OLUWATONI ARINOLA OKUBOYEJO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2022
Last Update Date: 11/21/2025
Certification Date: 11/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13114 FM 1960 RD W
HOUSTON TX
77065-4290
US

IV. Provider business mailing address

833 CHESTNUT ST STE 301
PHILADELPHIA PA
19107-4405
US

V. Phone/Fax

Practice location:
  • Phone: 281-890-6446
  • Fax:
Mailing address:
  • Phone: 215-955-2363
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD486736
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberV6661
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: