Provider Demographics
NPI:1639642978
Name:SOBOLA, OLADIMEJI OLANREWAJU
Entity Type:Individual
Prefix:
First Name:OLADIMEJI
Middle Name:OLANREWAJU
Last Name:SOBOLA
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 1:24139 AVOGADRO DR
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77493-3291
Mailing Address - Country:US
Mailing Address - Phone:951-224-1269
Mailing Address - Fax:
Practice Address - Street 1:24139 AVOGADRO DR
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77493-3291
Practice Address - Country:US
Practice Address - Phone:951-224-1269
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-09
Last Update Date:2019-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX874035163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse