MEDICARE: OLUSHOLA RAYMOND OJUGO SR.

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	343900000X	Non-emergency Medical Transport (VAN)	NZD-1643	TX

General Provider Information

NPI Number	:	1760166888
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OLUSHOLA RAYMOND OJUGO SR.

Provider Business Mailing Address
First Line	:	20802 BRADLEY GARDENS DR
Second Line	:
City	:	SPRING
State	:	TX
Zip	:	77379-1592
Country	:	US
Telephone Number	:	469-212-2303
Fax Number	:

Provider Business Practice Location Address
First Line	:	20802 BRADLEY GARDENS DR
Second Line	:
City	:	SPRING
State	:	TX
Zip	:	77379-1592
Country	:	US
Telephone Number	:	469-212-2303
Fax Number	:

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

Provider Enumeration Date	:	06/09/2023
Last Update Date	:	06/09/2023

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