Healthcare Provider Details

I. General information

NPI: 1619989142
Provider Name (Legal Business Name): LYDIA OLUWATOYIN NJAMFA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2006
Last Update Date: 02/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

708 W SPRING VALLEY RD
RICHARDSON TX
75080-7216
US

IV. Provider business mailing address

708 W SPRING VALLEY RD SUITE 399
RICHARDSON TX
75080-7216
US

V. Phone/Fax

Practice location:
  • Phone: 214-570-9400
  • Fax:
Mailing address:
  • Phone: 214-570-9400
  • Fax: 972-792-7268

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberL0884
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: