Provider Demographics
NPI:1275904260
Name:ADEROGBA, OYEBOADE
Entity Type:Individual
Prefix:
First Name:OYEBOADE
Middle Name:
Last Name:ADEROGBA
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 1:2703 HIGHWAY 6 S STE 195
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77082-1732
Mailing Address - Country:US
Mailing Address - Phone:281-854-7089
Mailing Address - Fax:281-496-4113
Practice Address - Street 1:2703 HIGHWAY 6 S STE 195
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77082-1732
Practice Address - Country:US
Practice Address - Phone:281-854-7089
Practice Address - Fax:281-496-4113
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-15
Last Update Date:2015-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)