Healthcare Provider Details

I. General information

NPI: 1699377655
Provider Name (Legal Business Name): TOLULOPE ADUFE SODIMU PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/13/2020
Last Update Date: 08/11/2025
Certification Date: 08/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2255 E MOSSY OAKS RD STE 320
SPRING TX
77389-1812
US

IV. Provider business mailing address

22710 PROFESSIONAL DR STE 202
KINGWOOD TX
77339-6009
US

V. Phone/Fax

Practice location:
  • Phone: 936-266-2195
  • Fax:
Mailing address:
  • Phone: 281-312-8521
  • Fax: 281-359-7971

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA13997
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: