1366679573 NPI number — DR. IYABODE MUNIRAT OGUNLADE M.D.

Table of content: DR. IYABODE MUNIRAT OGUNLADE M.D. (NPI 1366679573)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366679573 NPI number — DR. IYABODE MUNIRAT OGUNLADE M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
OGUNLADE
Provider First Name:
IYABODE
Provider Middle Name:
MUNIRAT
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
AGBOOLA
Provider Other First Name:
IYABODE
Provider Other Middle Name:
MUNIRAT
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1366679573
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/17/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13523 HARGRAVE ROAD
Provider Second Line Business Mailing Address:
PRISTINE OB-GYN CARE
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77070
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-206-4496
Provider Business Mailing Address Fax Number:
281-206-4487

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13523 HARGRAVE ROAD
Provider Second Line Business Practice Location Address:
PRISTINE OB-GYN CARE
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77070
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-206-4496
Provider Business Practice Location Address Fax Number:
281-206-4487
Provider Enumeration Date:
06/15/2009

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: 207V00000X , with the licence number:  M8471 , 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: 207569903 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".