MEDICARE: SIYA OLOSO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	889198	TX
2	363LF0000X	Family Nurse Practitioner	1021028	TX

General Provider Information

NPI Number	:	1023631884
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SIYA OLOSO

Provider Business Mailing Address
First Line	:	11627 CURATE WIND CT
Second Line	:
City	:	RICHMOND
State	:	TX
Zip	:	77407-2255
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9725 HOMESTEAD RD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77016-4403
Country	:	US
Telephone Number	:	713-829-7595
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/27/2020
Last Update Date	:	03/01/2021

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Directions to “ SIYA OLOSO ” Practice Location

Language	Start Address	Practice Location

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