Provider Demographics
NPI:1205196425
Name:OLALOWO, CELINAH OMOTELOLA (MD)
Entity Type:Individual
Prefix:
First Name:CELINAH
Middle Name:OMOTELOLA
Last Name:OLALOWO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7330 SAN PEDRO AVE
Mailing Address - Street 2:SUITE 540
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78216-6235
Mailing Address - Country:US
Mailing Address - Phone:210-344-2673
Mailing Address - Fax:210-344-2649
Practice Address - Street 1:7330 SAN PEDRO AVE
Practice Address - Street 2:SUITE 540
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78216-6235
Practice Address - Country:US
Practice Address - Phone:210-344-2673
Practice Address - Fax:210-344-2649
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-22
Last Update Date:2013-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP3784207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX308252101Medicaid