Provider Demographics
NPI:1225542517
Name:AKINWONMI, OKANLAWON JAMIU
Entity Type:Individual
Prefix:
First Name:OKANLAWON
Middle Name:JAMIU
Last Name:AKINWONMI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16303 LA GLORIA DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77083-2830
Mailing Address - Country:US
Mailing Address - Phone:725-333-5266
Mailing Address - Fax:
Practice Address - Street 1:16303 LA GLORIA DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77083-2830
Practice Address - Country:US
Practice Address - Phone:725-333-5266
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-22
Last Update Date:2017-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health