Provider Demographics
NPI:1780176222
Name:OLAJIDE, ABIBAT OMOLOLA
Entity type:Individual
Prefix:
First Name:ABIBAT
Middle Name:OMOLOLA
Last Name:OLAJIDE
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 1:7611 SAN BENITO DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77083-4409
Mailing Address - Country:US
Mailing Address - Phone:832-289-1572
Mailing Address - Fax:
Practice Address - Street 1:7611 SAN BENITO DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77083-4409
Practice Address - Country:US
Practice Address - Phone:832-289-1572
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-31
Last Update Date:2018-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX942384163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse