Healthcare Provider Details

I. General information

NPI: 1760027783
Provider Name (Legal Business Name): MS. OMOBOLA PATRICIA OLORUNSIWA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. AHUNNA BLESSING WELLS

II. Dates (important events)

Enumeration Date: 11/13/2019
Last Update Date: 11/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6403 SIERRA BLANCA DR APT 502
HOUSTON TX
77083-1530
US

IV. Provider business mailing address

6403 SIERRA BLANCA DR APT 50210000
HOUSTON TX
77083-1544
US

V. Phone/Fax

Practice location:
  • Phone: 505-712-9948
  • Fax:
Mailing address:
  • Phone: 505-712-9948
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: