Healthcare Provider Details

I. General information

NPI: 1972813822
Provider Name (Legal Business Name): ABIODUN OWORU
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/13/2010
Last Update Date: 10/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12236 BOB WHITE DR
HOUSTON TX
77035-5291
US

IV. Provider business mailing address

12236 BOB WHITE DR
HOUSTON TX
77035-5291
US

V. Phone/Fax

Practice location:
  • Phone: 713-729-3066
  • Fax:
Mailing address:
  • Phone: 713-729-3066
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: