=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033613922
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | OLUWASEYI OLAYINKA M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/23/2018
-----------------------------------------------------
Last Update Date | 08/05/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4600 E SAM HOUSTON PKWY SOUTH
-----------------------------------------------------
City | PASADENA
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77505-3948
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-481-3594
-----------------------------------------------------
Fax | 713-481-3588
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 676512
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75267-6512
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-481-3594
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207ZP0102X
-----------------------------------------------------
Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
-----------------------------------------------------
License Number | V0494
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------