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General NPI Number Information
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NPI Number | 1881123164
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Entity Type | Individual
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Provider Name | MR. ADENIYI O OLUSOGA
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Gender | Male
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Dates
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Enumeration Date | 06/08/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 4004 GREENWOOD WAY
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City | MANSFIELD
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State | TX
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Zip | 76063
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Country | US
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Telephone | 848-203-7728
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Fax |
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Provider Business Mailing Address
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Address Line | 4004 GREENWOOD WAY
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City | MANSFIELD
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State | TX
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Zip | 76063-5560
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Country | US
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Telephone | 848-203-7728
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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 | 372500000X
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Taxonomy Name | Chore Provider
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License Number |
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License Number State |
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