Provider Demographics
NPI:1578066858
Name:OGUNBODEDE, TOLULOPE
Entity Type:Individual
Prefix:
First Name:TOLULOPE
Middle Name:
Last Name:OGUNBODEDE
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 1:5033 SAVANNAH CLUB DR APT 723
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76017-0889
Mailing Address - Country:US
Mailing Address - Phone:817-504-0473
Mailing Address - Fax:
Practice Address - Street 1:5033 SAVANNAH CLUB DR APT 723
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76017-0889
Practice Address - Country:US
Practice Address - Phone:181-750-4047
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-14
Last Update Date:2018-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX307361164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse