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General NPI Number Information
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NPI Number | 1144545435
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Entity Type | Individual
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Provider Name | ISRAELDIVINE OLA KUYINU PHD, MHS, PA-C
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Gender | Male
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Dates
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Enumeration Date | 03/30/2010
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Last Update Date | 04/20/2024
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Provider Practice Location Address
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Address Line | 8130 MORNING ROSE LN
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City | HOUSTON
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State | TX
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Zip | 77095-4954
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Country | US
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Telephone | 346-624-7207
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Fax |
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Provider Business Mailing Address
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Address Line | 8130 MORNING ROSE LN
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City | HOUSTON
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State | TX
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Zip | 77095-4954
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Country | US
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Telephone | 281-830-2533
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 175F00000X
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Taxonomy Name | Naturopath
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA06693
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 175L00000X
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Taxonomy Name | Homeopath
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA06693
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License Number State | TX
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Taxonomy #5
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | PA06693
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License Number State | TX
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