1295869766 NPI number — DR. OMOWUMI LADIPO

Table of content: DR. OMOWUMI LADIPO (NPI 1295869766)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295869766 NPI number — DR. OMOWUMI LADIPO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LADIPO
Provider First Name:
OMOWUMI
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1295869766
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/06/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3809 ATASCOCITA RD
Provider Second Line Business Mailing Address:
SUITE 700
Provider Business Mailing Address City Name:
HUMBLE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77396-4631
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-446-0225
Provider Business Mailing Address Fax Number:
281-271-8048

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3809 ATASCOCITA RD
Provider Second Line Business Practice Location Address:
SUITE 700
Provider Business Practice Location Address City Name:
HUMBLE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77396-4631
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-446-0225
Provider Business Practice Location Address Fax Number:
281-271-8048
Provider Enumeration Date:
03/15/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  22543 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1791394-03 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 179139404 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1791394-02 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1791394-01 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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