Provider Demographics
NPI:1609637339
Name:OLUMOROTI, DAVID
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:OLUMOROTI
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 1:7106 GOLDEN GROUNDSEL DR
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77493-4342
Mailing Address - Country:US
Mailing Address - Phone:832-533-0213
Mailing Address - Fax:
Practice Address - Street 1:7106 GOLDEN GROUNDSEL DR
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77493-4342
Practice Address - Country:US
Practice Address - Phone:832-533-0213
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-19
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home