Provider Demographics
NPI:1457060972
Name:PALM OAKS FAMILY PRACTICE
Entity Type:Organization
Organization Name:PALM OAKS FAMILY PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ABIOLA
Authorized Official - Middle Name:
Authorized Official - Last Name:OPABUNMI
Authorized Official - Suffix:
Authorized Official - Credentials:AGNP
Authorized Official - Phone:281-603-0800
Mailing Address - Street 1:12526 TAMARON DR
Mailing Address - Street 2:
Mailing Address - City:LA MARQUE
Mailing Address - State:TX
Mailing Address - Zip Code:77568-2561
Mailing Address - Country:US
Mailing Address - Phone:917-406-7455
Mailing Address - Fax:409-299-3773
Practice Address - Street 1:17041 EL CAMINO REAL STE 203
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77058-2646
Practice Address - Country:US
Practice Address - Phone:281-603-0800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-23
Last Update Date:2022-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center