Healthcare Provider Details

I. General information

NPI: 1952623126
Provider Name (Legal Business Name): RACHAEL O OGUNLEYE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/15/2010
Last Update Date: 02/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 CANDISE CT
MESQUITE TX
75149-5511
US

IV. Provider business mailing address

1400 CANDISE CT
MESQUITE TX
75149-5511
US

V. Phone/Fax

Practice location:
  • Phone: 214-783-3992
  • Fax: 866-728-5785
Mailing address:
  • Phone: 214-783-3992
  • Fax: 866-728-5785

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: