Provider Demographics
NPI:1760619274
Name:OKUNADE, CHRISTIANAH FOLUKE
Entity Type:Individual
Prefix:MS
First Name:CHRISTIANAH
Middle Name:FOLUKE
Last Name:OKUNADE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11325 PEGASUS ST
Mailing Address - Street 2:STE E138
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75238-5219
Mailing Address - Country:US
Mailing Address - Phone:214-221-4900
Mailing Address - Fax:214-221-4908
Practice Address - Street 1:11325 PEGASUS ST
Practice Address - Street 2:STE E138
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75238-5219
Practice Address - Country:US
Practice Address - Phone:214-221-4900
Practice Address - Fax:214-221-4908
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-11
Last Update Date:2016-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1786238Medicaid
TX673108Medicare Oscar/Certification
673108Medicare Oscar/Certification