Provider Demographics
NPI:1275393506
Name:OGUNTODU, OLAYINKA
Entity Type:Individual
Prefix:
First Name:OLAYINKA
Middle Name:
Last Name:OGUNTODU
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 1:1148 WAGGONER DR
Mailing Address - Street 2:
Mailing Address - City:CROSS ROADS
Mailing Address - State:TX
Mailing Address - Zip Code:76227-4514
Mailing Address - Country:US
Mailing Address - Phone:469-479-7134
Mailing Address - Fax:
Practice Address - Street 1:1148 WAGGONER DR
Practice Address - Street 2:
Practice Address - City:CROSS ROADS
Practice Address - State:TX
Practice Address - Zip Code:76227-4514
Practice Address - Country:US
Practice Address - Phone:469-479-7134
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-21
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)