Provider Demographics
NPI:1205424694
Name:BALOGUN, OLUWATOSIN AISHAT
Entity type:Individual
Prefix:
First Name:OLUWATOSIN
Middle Name:AISHAT
Last Name:BALOGUN
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 1:450 GEARS RD STE 450
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77067-4542
Mailing Address - Country:US
Mailing Address - Phone:281-874-0212
Mailing Address - Fax:
Practice Address - Street 1:26750 FM 1093 RD STE 170
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77406-2786
Practice Address - Country:US
Practice Address - Phone:281-875-8428
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-02
Last Update Date:2024-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1035445363LF0000X
FLRN9387682163W00000X
GARN301656363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse