Healthcare Provider Details

I. General information

NPI: 1780391516
Provider Name (Legal Business Name): MRS. ADUNOLA MONISOLA OGUNLEYE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2022
Last Update Date: 11/01/2022
Certification Date: 11/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4301 VISTA RD
PASADENA TX
77504-2117
US

IV. Provider business mailing address

4301 VISTA RD
PASADENA TX
77504-2117
US

V. Phone/Fax

Practice location:
  • Phone: 713-378-3000
  • Fax:
Mailing address:
  • Phone: 713-378-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1090342
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: