MEDICARE: MR. ADEDEJI AGBOOLA ADEYANJU CERTIFIED PHLEBOTOMY

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	246RP1900X	Phlebotomy Technician	NPCN-17788-18467	TX

General Provider Information

NPI Number	:	1194660787
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ADEDEJI AGBOOLA ADEYANJU CERTIFIED PHLEBOTOMY

Provider Business Mailing Address
First Line	:	9898 BISSONNET ST STE 375E
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77036-8270
Country	:	US
Telephone Number	:	183-229-1262
Fax Number	:

Provider Business Practice Location Address
First Line	:	9898 BISSONNET ST STE 375E
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77036-8270
Country	:	US
Telephone Number	:	507-317-8742
Fax Number	:

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

Provider Enumeration Date	:	04/21/2026
Last Update Date	:	05/19/2026

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