Provider Demographics
NPI:1760166888
Name:OJUGO, OLUSHOLA RAYMOND SR
Entity Type:Individual
Prefix:
First Name:OLUSHOLA
Middle Name:RAYMOND
Last Name:OJUGO
Suffix:SR
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 1:20802 BRADLEY GARDENS DR
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77379-1592
Mailing Address - Country:US
Mailing Address - Phone:469-212-2303
Mailing Address - Fax:
Practice Address - Street 1:20802 BRADLEY GARDENS DR
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77379-1592
Practice Address - Country:US
Practice Address - Phone:469-212-2303
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-09
Last Update Date:2023-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXNZD-1643343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)