Healthcare Provider Details

I. General information

NPI: 1386972511
Provider Name (Legal Business Name): OLUWAGBEMIGA LONGE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2009
Last Update Date: 11/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18438 AUSTIN OAK LN
RICHMOND TX
77407-2276
US

IV. Provider business mailing address

18438 AUSTIN OAK LN
RICHMOND TX
77407-2276
US

V. Phone/Fax

Practice location:
  • Phone: 281-751-8282
  • Fax: 281-751-8282
Mailing address:
  • Phone: 281-751-8282
  • Fax: 281-751-8282

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. OLUWAGBEMIGA LONGE
Title or Position: OWNER/ADMINISTRATOR
Credential:
Phone: 281-751-8282