Provider Demographics
NPI:1942929583
Name:OLUGBUSI, ESTHER IDUNNU
Entity Type:Individual
Prefix:
First Name:ESTHER
Middle Name:IDUNNU
Last Name:OLUGBUSI
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 1:8903 ROLLICK DR
Mailing Address - Street 2:
Mailing Address - City:TOMBALL
Mailing Address - State:TX
Mailing Address - Zip Code:77375-8005
Mailing Address - Country:US
Mailing Address - Phone:401-301-7968
Mailing Address - Fax:
Practice Address - Street 1:2901 RILEY FUZZEL RD
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77386-4489
Practice Address - Country:US
Practice Address - Phone:832-823-7086
Practice Address - Fax:832-823-7315
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-25
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX40415390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program