Healthcare Provider Details

I. General information

NPI: 1922010479
Provider Name (Legal Business Name): LYDIA O. NJAMFA, MD.PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2006
Last Update Date: 10/01/2019
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
RICHARDSON TX
75080-7216
US

V. Phone/Fax

Practice location:
  • Phone: 214-570-9400
  • Fax: 972-792-7246
Mailing address:
  • Phone: 214-570-9400
  • Fax: 972-792-7246

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: DR. LYDIA OLUWATOYIN NJAMFA
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 214-570-9400