Provider Demographics
NPI:1255623864
Name:OGUNBIYI, ADEBOLA (NP)
Entity type:Individual
Prefix:
First Name:ADEBOLA
Middle Name:
Last Name:OGUNBIYI
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6302 BROADWAY ST STE 130
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77581-7859
Mailing Address - Country:US
Mailing Address - Phone:832-438-0330
Mailing Address - Fax:
Practice Address - Street 1:6302 BROADWAY ST STE 130
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77581-7859
Practice Address - Country:US
Practice Address - Phone:832-438-0330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-15
Last Update Date:2024-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1082133363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health