Provider Demographics
NPI:1750595047
Name:MOGAJI, MARIAM MOJISOLA
Entity type:Individual
Prefix:
First Name:MARIAM
Middle Name:MOJISOLA
Last Name:MOGAJI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3322 S SUTTON SQ
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:TX
Mailing Address - Zip Code:77477-4721
Mailing Address - Country:US
Mailing Address - Phone:713-779-4300
Mailing Address - Fax:713-779-4380
Practice Address - Street 1:3322 S SUTTON SQ
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:TX
Practice Address - Zip Code:77477-4721
Practice Address - Country:US
Practice Address - Phone:713-779-4300
Practice Address - Fax:713-779-4380
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX010007163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXLICENSE# 010007OtherLICENSED HOME HEALTH &PAS