Healthcare Provider Details

I. General information

NPI: 1255623864
Provider Name (Legal Business Name): ADEBOLA OGUNBIYI NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2011
Last Update Date: 08/22/2024
Certification Date: 08/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6302 BROADWAY ST STE 130
PEARLAND TX
77581-7859
US

IV. Provider business mailing address

6302 BROADWAY ST STE 130
PEARLAND TX
77581-7859
US

V. Phone/Fax

Practice location:
  • Phone: 832-438-0330
  • Fax:
Mailing address:
  • Phone: 832-438-0330
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number1082133
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: