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General NPI Number Information
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NPI Number | 1821651910
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Entity Type | Individual
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Provider Name | AIMEBENOMON OMOYE IDAHOSA MD
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Gender | Female
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Dates
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Enumeration Date | 04/15/2019
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Last Update Date | 10/08/2025
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Provider Practice Location Address
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Address Line | 2443 FILLMORE ST # 38015799
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City | SAN FRANCISCO
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State | CA
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Zip | 94115-1814
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Country | US
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Telephone | 165-086-5517
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Fax | 165-035-2522
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Provider Business Mailing Address
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Address Line | 1122 W 16TH ST UNIT F
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City | HOUSTON
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State | TX
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Zip | 77008-4785
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Country | US
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Telephone | 317-702-8812
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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 | 2083B0002X
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Taxonomy Name | Obesity Medicine (Preventive Medicine) Physician
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License Number | T5926
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | T5926
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License Number State | TX
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