Provider Demographics
NPI:1487028619
Name:KOTUN, RASAQ ADENIYI (TRANSPORTATION PROVI)
Entity Type:Individual
Prefix:
First Name:RASAQ
Middle Name:ADENIYI
Last Name:KOTUN
Suffix:
Gender:M
Credentials:TRANSPORTATION PROVI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2611 CYPRESS CREEK PKWY
Mailing Address - Street 2:F-102
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77068-3731
Mailing Address - Country:US
Mailing Address - Phone:713-875-9776
Mailing Address - Fax:
Practice Address - Street 1:2611 CYPRESS CREEK PKWY
Practice Address - Street 2:F-102
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77068-3731
Practice Address - Country:US
Practice Address - Phone:713-875-9776
Practice Address - Fax:281-973-0970
Is Sole Proprietor?:No
Enumeration Date:2015-11-27
Last Update Date:2015-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14373015172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver