1144578733 NPI number — DR. OLUSOLA FRANCISCA OMOOLAYE-ONOVIRAN MD

Table of content: DR. OLUSOLA FRANCISCA OMOOLAYE-ONOVIRAN MD (NPI 1144578733)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144578733 NPI number — DR. OLUSOLA FRANCISCA OMOOLAYE-ONOVIRAN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
OMOOLAYE-ONOVIRAN
Provider First Name:
OLUSOLA
Provider Middle Name:
FRANCISCA
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
OMOOLAYE
Provider Other First Name:
OLUSOLA
Provider Other Middle Name:
FRANCISCA
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1144578733
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/30/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
301 UNIVERSITY BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GALVESTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77555-0567
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
832-505-2100
Provider Business Mailing Address Fax Number:
281-337-0704

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
301 UNIVERSITY BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GALVESTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77555-0567
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
832-505-2100
Provider Business Practice Location Address Fax Number:
281-337-0704
Provider Enumeration Date:
08/29/2012

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: 207RG0300X , with the licence number:  BP10052132 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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