Healthcare Provider Details

I. General information

NPI: 1477202240
Provider Name (Legal Business Name): ITAI OJO DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2022
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

134 VISION PARK BLVD STE 250
SHENANDOAH TX
77384-3031
US

IV. Provider business mailing address

10154 TIGER FLOWER LN
HOUSTON TX
77016-1346
US

V. Phone/Fax

Practice location:
  • Phone: 832-246-8935
  • Fax:
Mailing address:
  • Phone: 832-507-9054
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberW2338
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: