Provider Demographics
NPI:1497087100
Name:OSEMWOTA, PAUL (ADMINISTRATOR)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:OSEMWOTA
Suffix:
Gender:M
Credentials:ADMINISTRATOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6318 DRYAD DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77035-6605
Mailing Address - Country:US
Mailing Address - Phone:713-729-3472
Mailing Address - Fax:713-729-2482
Practice Address - Street 1:6318 DRYAD DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77035-6605
Practice Address - Country:US
Practice Address - Phone:713-729-3472
Practice Address - Fax:713-729-2482
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-04
Last Update Date:2010-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1000344341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX900446862OtherEIN