Provider Demographics
NPI:1376095257
Name:CULPEPPER, OLUBOLA
Entity Type:Individual
Prefix:
First Name:OLUBOLA
Middle Name:
Last Name:CULPEPPER
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 1:11802 SHARPVIEW DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77072-2810
Mailing Address - Country:US
Mailing Address - Phone:832-338-5637
Mailing Address - Fax:281-988-6245
Practice Address - Street 1:11802 SHARPVIEW DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77072-2810
Practice Address - Country:US
Practice Address - Phone:832-338-5637
Practice Address - Fax:281-988-6245
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-26
Last Update Date:2016-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX144902172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker