1356370613 NPI number — OLUSEGUN B. AWOTESU

Table of content: (NPI 1356370613)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356370613 NPI number — OLUSEGUN B. AWOTESU

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OLUSEGUN B. AWOTESU
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
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:
1356370613
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/10/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8700 COMMERCE PARK DR STE 201
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77036-7430
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
713-484-6046
Provider Business Mailing Address Fax Number:
832-603-4153

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8700 COMMERCE PARK DR STE 201
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77036-7430
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-484-6046
Provider Business Practice Location Address Fax Number:
832-603-4153
Provider Enumeration Date:
06/30/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
AWOTESU
Authorized Official First Name:
OLUSEGUN
Authorized Official Middle Name:
BABATUNDE
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
713-484-6046

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  010419 , 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)