Provider Demographics
NPI:1093125668
Name:YEJIDE OLUSOLA OLUDARE
Entity Type:Organization
Organization Name:YEJIDE OLUSOLA OLUDARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RN-BSN
Authorized Official - Prefix:MRS
Authorized Official - First Name:YEJIDE
Authorized Official - Middle Name:OLUSOLA
Authorized Official - Last Name:OLUDARE
Authorized Official - Suffix:
Authorized Official - Credentials:DON
Authorized Official - Phone:361-343-0695
Mailing Address - Street 1:12014 NEWTON TRL
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78253-5696
Mailing Address - Country:US
Mailing Address - Phone:361-343-0695
Mailing Address - Fax:
Practice Address - Street 1:12014 NEWTON TRL
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78253-5696
Practice Address - Country:US
Practice Address - Phone:361-343-0695
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-05
Last Update Date:2015-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health