Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0300X | Geriatric Medicine | BP10052132 | TX |
NPI | 1144578733 |
---|---|
Provider Name | Dr. Olusola Francisca Omoolaye-Onoviran |
First Address | Galveston, TX 77555-0567 |
Second Address | Galveston, TX 77555-0567 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/08/2012 |
Last Update Date | 30/04/2015 |