Provider Demographics
NPI:1003453671
Name:EBIMA OKUNDAYE P.A.
Entity Type:Organization
Organization Name:EBIMA OKUNDAYE P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EBIMA
Authorized Official - Middle Name:
Authorized Official - Last Name:OKUNDAYE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-885-5457
Mailing Address - Street 1:PO BOX 1571
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:TX
Mailing Address - Zip Code:77545-1571
Mailing Address - Country:US
Mailing Address - Phone:832-831-6135
Mailing Address - Fax:832-925-8917
Practice Address - Street 1:3315 BURKE RD STE 306
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77504-1825
Practice Address - Country:US
Practice Address - Phone:832-831-6135
Practice Address - Fax:832-925-8917
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-03
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty