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General NPI Number Information
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NPI Number | 1518989474
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Entity Type | Individual
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Provider Name | OMOTAYO ONANUGA MD
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Gender | Male
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Dates
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Enumeration Date | 07/23/2006
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Last Update Date | 11/21/2024
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Provider Practice Location Address
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Address Line | 833 E NORTHWEST HWY STE 400
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City | GRAPEVINE
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State | TX
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Zip | 76051-3302
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Country | US
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Telephone | 817-778-0191
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Fax | 817-421-2940
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Provider Business Mailing Address
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Address Line | P.O. BOX 2043
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City | GRAPEVINE
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State | TX
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Zip | 76099
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Country | US
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Telephone | 817-778-0191
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Fax | 817-241-2940
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | P7684
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License Number State | TX
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