Provider Demographics
NPI:1386509321
Name:OLAITAN, MATTHEW B
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:B
Last Name:OLAITAN
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 1:12463 CHAZELLE
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78254-4856
Mailing Address - Country:US
Mailing Address - Phone:401-450-8218
Mailing Address - Fax:401-450-8218
Practice Address - Street 1:12463 CHAZELLE
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78254-4856
Practice Address - Country:US
Practice Address - Phone:401-450-8218
Practice Address - Fax:401-450-8218
Is Sole Proprietor?:Yes
Enumeration Date:2025-12-22
Last Update Date:2025-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1071964163WC0400X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WC0400XNursing Service ProvidersRegistered NurseCase Management