Healthcare Provider Details

I. General information

NPI: 1508499245
Provider Name (Legal Business Name): OLUBUNMI OGUNADE-LAWAL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2020
Last Update Date: 02/21/2020
Certification Date: 02/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3010 TANDEM CT
ROSENBERG TX
77471-1982
US

IV. Provider business mailing address

1155 DAIRY ASHFORD RD STE 560
HOUSTON TX
77079-3035
US

V. Phone/Fax

Practice location:
  • Phone: 832-889-6511
  • Fax:
Mailing address:
  • Phone: 713-799-2200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number986639
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: