Provider Demographics
NPI:1851916068
Name:OYELOLA, MORIAM O
Entity Type:Individual
Prefix:
First Name:MORIAM
Middle Name:O
Last Name:OYELOLA
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 1:10500 FOUNTAIN LAKE DR APT 331
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:TX
Mailing Address - Zip Code:77477-3749
Mailing Address - Country:US
Mailing Address - Phone:432-599-2615
Mailing Address - Fax:
Practice Address - Street 1:10500 FOUNTAIN LAKE DR APT 331
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:TX
Practice Address - Zip Code:77477-3749
Practice Address - Country:US
Practice Address - Phone:432-599-2615
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-12
Last Update Date:2020-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider