Healthcare Provider Details

I. General information

NPI: 1962423798
Provider Name (Legal Business Name): VICTOR O A OGUNLANA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2408 N CONWAY AVE
MISSION TX
78572
US

IV. Provider business mailing address

PO BOX 3239
MISSION TX
78573
US

V. Phone/Fax

Practice location:
  • Phone: 956-519-2800
  • Fax: 956-519-9424
Mailing address:
  • Phone: 956-519-2800
  • Fax: 956-519-9424

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberL0467
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: