Healthcare Provider Details

I. General information

NPI: 1598462335
Provider Name (Legal Business Name): TOLUWALASE EKUNDAYO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/13/2023
Last Update Date: 01/05/2024
Certification Date: 01/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13656 BRETON RIDGE ST UNITS A & H
HOUSTON TX
77070
US

IV. Provider business mailing address

PO BOX 1625
RICHMOND TX
77406-0041
US

V. Phone/Fax

Practice location:
  • Phone: 281-429-8780
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: