Healthcare Provider Details

I. General information

NPI: 1598932410
Provider Name (Legal Business Name): OMOLARA VIOLET ADERINBOYE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/09/2008
Last Update Date: 04/26/2022
Certification Date: 04/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2601 DIMMITT RD
PLAINVIEW TX
79072-1833
US

IV. Provider business mailing address

2215 NASHVILLE AVE
LUBBOCK TX
79410-1105
US

V. Phone/Fax

Practice location:
  • Phone: 806-296-5531
  • Fax: 806-291-5688
Mailing address:
  • Phone: 806-725-5844
  • Fax: 806-723-6532

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberN4233
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code2080P0208X
TaxonomyPediatric Infectious Diseases Physician
License Number252132
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code2080P0208X
TaxonomyPediatric Infectious Diseases Physician
License NumberN4233
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberN4233
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: