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General NPI Number Information
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NPI Number | 1598147811
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Entity Type | Individual
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Provider Name | COLLINS ADEAGBO
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Gender | Male
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Dates
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Enumeration Date | 06/23/2015
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Last Update Date | 06/23/2015
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Provider Practice Location Address
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Address Line | 207 BALSAM GROVE CIR
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City | DESOTO
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State | TX
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Zip | 75115-5361
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Country | US
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Telephone | 469-463-3061
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Fax |
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Provider Business Mailing Address
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Address Line | 207 BALSAM GROVE CIR
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City | DESOTO
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State | TX
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Zip | 75115-5361
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Country | US
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Telephone |
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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 | 246Z00000X
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Taxonomy Name | Other Specialist/Technologist
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License Number | 2556790
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 247000000X
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Taxonomy Name | Health Information Technician
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License Number | 2355690
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 255690
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License Number State | TX
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Taxonomy #4
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Taxonomy Code | 251K00000X
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Taxonomy Name | Public Health or Welfare Agency
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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