Provider Demographics
NPI:1336847292
Name:EZEKIEL, OLUWADAMILARE PRECIOUS
Entity Type:Individual
Prefix:
First Name:OLUWADAMILARE
Middle Name:PRECIOUS
Last Name:EZEKIEL
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 1:1870 SWEARINGER DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPGS
Mailing Address - State:CO
Mailing Address - Zip Code:80906-5442
Mailing Address - Country:US
Mailing Address - Phone:561-644-8761
Mailing Address - Fax:
Practice Address - Street 1:1079 SPACE CENTER DR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80915-3612
Practice Address - Country:US
Practice Address - Phone:888-754-0398
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-21
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
06030401OtherI DON'T HAVE ONE