Provider Demographics
NPI:1346011954
Name:ODEYALE, ADEBISI
Entity Type:Individual
Prefix:MR
First Name:ADEBISI
Middle Name:
Last Name:ODEYALE
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 1:22715 IMPERIAL VALLEY DR APT 901
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77073-1137
Mailing Address - Country:US
Mailing Address - Phone:502-716-2686
Mailing Address - Fax:
Practice Address - Street 1:22715 IMPERIAL VALLEY DR APT 901
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77073-1137
Practice Address - Country:US
Practice Address - Phone:502-716-2686
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-11
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant