Provider Demographics
NPI:1356370613
Name:OLUSEGUN B. AWOTESU
Entity type:Organization
Organization Name:OLUSEGUN B. AWOTESU
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:OLUSEGUN
Authorized Official - Middle Name:BABATUNDE
Authorized Official - Last Name:AWOTESU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-484-6046
Mailing Address - Street 1:8700 COMMERCE PARK DR STE 201
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77036-7430
Mailing Address - Country:US
Mailing Address - Phone:713-484-6046
Mailing Address - Fax:832-603-4153
Practice Address - Street 1:8700 COMMERCE PARK DR STE 201
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77036-7430
Practice Address - Country:US
Practice Address - Phone:713-484-6046
Practice Address - Fax:832-603-4153
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-30
Last Update Date:2007-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX010419251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health