MEDICARE: MR. FRANCIS OLATUNDE AJELETI N/A

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	172V00000X	Community Health Worker

General Provider Information

NPI Number	:	1952666893
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. FRANCIS OLATUNDE AJELETI N/A

Provider Business Mailing Address
First Line	:	PO BOX 170
Second Line	:
City	:	STAFFORD
State	:	TX
Zip	:	77497-0170
Country	:	US
Telephone Number	:	832-423-8238
Fax Number	:	281-499-4902

Provider Business Practice Location Address
First Line	:	1802 ELM SHADOW DR
Second Line	:
City	:	MISSOURI CITY
State	:	TX
Zip	:	77489-2920
Country	:	US
Telephone Number	:	832-423-8238
Fax Number	:	281-499-4902

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

Provider Enumeration Date	:	07/06/2012
Last Update Date	:	07/06/2012

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