Provider Demographics
NPI:1265160600
Name:OMIDIWURA, TOLULOPE
Entity type:Individual
Prefix:
First Name:TOLULOPE
Middle Name:
Last Name:OMIDIWURA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12799 BISSONNET ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77099-1259
Mailing Address - Country:US
Mailing Address - Phone:832-641-9949
Mailing Address - Fax:
Practice Address - Street 1:12799 BISSONNET ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77099-1259
Practice Address - Country:US
Practice Address - Phone:832-641-9949
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-12
Last Update Date:2022-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes342000000XTransportation ServicesTransportation Network Company