MEDICARE: OLUWATOSIN VICTORIA OGUNTADE

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	1118181	TX

General Provider Information

NPI Number	:	1982420055
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OLUWATOSIN VICTORIA OGUNTADE

Provider Business Mailing Address
First Line	:	2207 LITTLE TREE BND
Second Line	:
City	:	CEDAR PARK
State	:	TX
Zip	:	78613-1529
Country	:	US
Telephone Number	:	945-249-2788
Fax Number	:

Provider Business Practice Location Address
First Line	:	2207 LITTLE TREE BND
Second Line	:
City	:	CEDAR PARK
State	:	TX
Zip	:	78613-1529
Country	:	US
Telephone Number	:	945-249-2788
Fax Number	:

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

Provider Enumeration Date	:	11/23/2024
Last Update Date	:	11/23/2024

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