Healthcare Provider Details

I. General information

NPI: 1942929583
Provider Name (Legal Business Name): ESTHER IDUNNU OLUGBUSI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2022
Last Update Date: 08/25/2022
Certification Date: 08/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2901 RILEY FUZZEL RD
SPRING TX
77386-4489
US

IV. Provider business mailing address

8903 ROLLICK DR
TOMBALL TX
77375-8005
US

V. Phone/Fax

Practice location:
  • Phone: 832-823-7086
  • Fax: 832-823-7315
Mailing address:
  • Phone: 401-301-7968
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number40415
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: