Provider Demographics
NPI:1699377655
Name:SODIMU, TOLULOPE ADUFE (PA-C)
Entity Type:Individual
Prefix:
First Name:TOLULOPE
Middle Name:ADUFE
Last Name:SODIMU
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22710 PROFESSIONAL DR STE 202
Mailing Address - Street 2:
Mailing Address - City:KINGWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77339-6009
Mailing Address - Country:US
Mailing Address - Phone:281-312-8521
Mailing Address - Fax:281-359-7971
Practice Address - Street 1:18532 KUYKENDAHL RD
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77379-8160
Practice Address - Country:US
Practice Address - Phone:713-804-5961
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-13
Last Update Date:2022-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA13997363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant