Provider Demographics
NPI:1942489943
Name:VICTOR O.A. OGUNLANA MD PA
Entity Type:Organization
Organization Name:VICTOR O.A. OGUNLANA MD PA
Other - Org Name:SHALOM PEDIATRICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:OA
Authorized Official - Last Name:OGUNLANA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:956-519-2800
Mailing Address - Street 1:PO BOX 3239
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78573-0055
Mailing Address - Country:US
Mailing Address - Phone:956-519-2800
Mailing Address - Fax:956-519-9424
Practice Address - Street 1:2408 N CONWAY AVE
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78574-2347
Practice Address - Country:US
Practice Address - Phone:956-519-2800
Practice Address - Fax:956-519-9424
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-26
Last Update Date:2007-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL0467208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty