Provider Demographics
NPI:1376961805
Name:OLATUNJI, TOY ERNEST
Entity Type:Individual
Prefix:MR
First Name:TOY
Middle Name:ERNEST
Last Name:OLATUNJI
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 1:14231 FM 1464 RD
Mailing Address - Street 2:11302
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77498-7641
Mailing Address - Country:US
Mailing Address - Phone:832-420-3932
Mailing Address - Fax:
Practice Address - Street 1:14231 FM 1464 RD
Practice Address - Street 2:11302
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77498-7641
Practice Address - Country:US
Practice Address - Phone:832-420-3932
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-02
Last Update Date:2014-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX172A00000X172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver