Provider Demographics
NPI:1760027783
Name:OLORUNSIWA, OMOBOLA PATRICIA
Entity Type:Individual
Prefix:MS
First Name:OMOBOLA
Middle Name:PATRICIA
Last Name:OLORUNSIWA
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:AHUNNA
Other - Middle Name:BLESSING
Other - Last Name:WELLS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:6403 SIERRA BLANCA DR APT 50210000
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77083-1544
Mailing Address - Country:US
Mailing Address - Phone:505-712-9948
Mailing Address - Fax:
Practice Address - Street 1:6403 SIERRA BLANCA DR APT 502
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77083-1530
Practice Address - Country:US
Practice Address - Phone:505-712-9948
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-13
Last Update Date:2019-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide