Provider Demographics
NPI:1003529322
Name:OGUNFEITIMI, OLUWAYEMISI ABIMBOLA
Entity type:Individual
Prefix:
First Name:OLUWAYEMISI
Middle Name:ABIMBOLA
Last Name:OGUNFEITIMI
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 1:8546 BROADWAY # 35
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78217-6376
Mailing Address - Country:US
Mailing Address - Phone:210-940-2764
Mailing Address - Fax:830-239-9930
Practice Address - Street 1:8546 BROADWAY # 35
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78217-6376
Practice Address - Country:US
Practice Address - Phone:210-940-2764
Practice Address - Fax:830-239-9930
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-02
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX700605363LP0808X, 163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health