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General NPI Number Information
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NPI Number | 1093125668
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Entity Type | Organization
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Legal Business Name | YEJIDE OLUSOLA OLUDARE
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Dates
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Enumeration Date | 05/05/2014
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Last Update Date | 06/01/2015
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Provider Practice Location Address
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Address Line | 12014 NEWTON TRL
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City | SAN ANTONIO
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State | TX
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Zip | 78253-5696
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Country | US
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Telephone | 361-343-0695
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Fax |
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Provider Business Mailing Address
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Address Line | 12014 NEWTON TRL
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City | SAN ANTONIO
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State | TX
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Zip | 78253-5696
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Country | US
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Telephone | 361-343-0695
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Fax |
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Authorized Official
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Title or Position | RN-BSN
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Name | MRS. YEJIDE OLUSOLA OLUDARE
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Credential | DON
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Telephone | 361-343-0695
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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