Healthcare Provider Details

I. General information

NPI: 1316689102
Provider Name (Legal Business Name): OLAYOMI OLONODE NP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/11/2022
Last Update Date: 03/18/2025
Certification Date: 03/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8700 COMMERCE PARK DR STE 218A
HOUSTON TX
77036-7431
US

IV. Provider business mailing address

8700 COMMERCE PARK DR STE 218A
HOUSTON TX
77036-7431
US

V. Phone/Fax

Practice location:
  • Phone: 832-907-5207
  • Fax:
Mailing address:
  • Phone: 832-907-5207
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95023639
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number1073330
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: