Provider Demographics
NPI:1396257481
Name:JAIYESIMI, PRINE ADELEKE
Entity type:Individual
Prefix:
First Name:PRINE ADELEKE
Middle Name:
Last Name:JAIYESIMI
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 1:7115 S MASON RD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77407-4474
Mailing Address - Country:US
Mailing Address - Phone:281-515-8439
Mailing Address - Fax:
Practice Address - Street 1:7115 S MASON RD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77407-4474
Practice Address - Country:US
Practice Address - Phone:281-515-8439
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-29
Last Update Date:2017-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343800000XTransportation ServicesSecured Medical Transport (VAN)