Healthcare Provider Details

I. General information

NPI: 1063044055
Provider Name (Legal Business Name): OMONIYI ADENIKE OGUNDIPE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/07/2020
Last Update Date: 02/07/2020
Certification Date: 02/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3003 SEAGLER RD APT 4112
HOUSTON TX
77042-3076
US

IV. Provider business mailing address

3003 SEAGLER RD APT 4112
HOUSTON TX
77042-3076
US

V. Phone/Fax

Practice location:
  • Phone: 404-910-8263
  • Fax:
Mailing address:
  • Phone: 404-910-8263
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: