Provider Demographics
NPI:1275861528
Name:OLUSANYA, OLUBUKOLA ABAKE
Entity Type:Individual
Prefix:
First Name:OLUBUKOLA
Middle Name:ABAKE
Last Name:OLUSANYA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9800 CENTRE PKWY
Mailing Address - Street 2:SUITE 655
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77036-8271
Mailing Address - Country:US
Mailing Address - Phone:713-589-5289
Mailing Address - Fax:713-995-1806
Practice Address - Street 1:9800 CENTRE PKWY
Practice Address - Street 2:SUITE 655
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77036-8271
Practice Address - Country:US
Practice Address - Phone:713-589-5289
Practice Address - Fax:713-995-1806
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-25
Last Update Date:2012-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX011283251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX011283OtherSTATE