MEDICARE: MR. JOSHUA OLUWASEGUN JAIYESIMI LVN

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	164X00000X	Licensed Vocational Nurse	321913	TX

General Provider Information

NPI Number	:	1548748551
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOSHUA OLUWASEGUN JAIYESIMI LVN

Provider Business Mailing Address
First Line	:	3505 W SAM HOUSTON PKWY S APT 1313
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77042-2089
Country	:	US
Telephone Number	:	786-326-0535
Fax Number	:

Provider Business Practice Location Address
First Line	:	11929 UNIVERSITY BLVD STE 2M
Second Line	:
City	:	SUGAR LAND
State	:	TX
Zip	:	77479-4757
Country	:	US
Telephone Number	:	281-238-8775
Fax Number	:

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

Provider Enumeration Date	:	08/01/2018
Last Update Date	:	08/01/2018

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