Provider Demographics
NPI:1477293306
Name:FIOLA, OLUSEGUN OLUMIDE
Entity Type:Individual
Prefix:MR
First Name:OLUSEGUN
Middle Name:OLUMIDE
Last Name:FIOLA
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 1:14405 RIO BONITO RD APT 184
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77083-1550
Mailing Address - Country:US
Mailing Address - Phone:183-250-3860
Mailing Address - Fax:
Practice Address - Street 1:14405 RIO BONITO RD APT 184
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77083-1550
Practice Address - Country:US
Practice Address - Phone:183-250-3860
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-30
Last Update Date:2022-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No347E00000XTransportation ServicesTransportation Broker