=====================================================
General NPI Number Information
=====================================================
NPI Number | 1538236955
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MUYIWA ADENUGA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/29/2006
-----------------------------------------------------
Last Update Date | 12/02/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10039 BISSONNET ST STE 214
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77036-7854
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-773-3330
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10039 BISSONNET ST STE 214
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77036-7854
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-773-3330
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MUYIWA ADENUGA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 713-773-3330
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332BP3500X
-----------------------------------------------------
Taxonomy Name | Parenteral & Enteral Nutrition Supplies (DME)
-----------------------------------------------------
License Number | 0091317
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------