Provider Demographics
NPI:1407611833
Name:OWOLABI, ABDULRAHMAN BOLAJI
Entity Type:Individual
Prefix:
First Name:ABDULRAHMAN
Middle Name:BOLAJI
Last Name:OWOLABI
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 1:10811 CLODINE RD # A
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77407-9503
Mailing Address - Country:US
Mailing Address - Phone:866-230-5771
Mailing Address - Fax:
Practice Address - Street 1:10811 CLODINE RD # A
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77407-9503
Practice Address - Country:US
Practice Address - Phone:866-230-5771
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-15
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX05468213172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver