Provider Demographics
NPI:1982385514
Name:OGUNJOBI, BUKOLA BANKOLE
Entity Type:Individual
Prefix:
First Name:BUKOLA
Middle Name:BANKOLE
Last Name:OGUNJOBI
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 1:1326 CRESS GARDEN LN
Mailing Address - Street 2:
Mailing Address - City:FORNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75126-3756
Mailing Address - Country:US
Mailing Address - Phone:240-702-4667
Mailing Address - Fax:
Practice Address - Street 1:1326 CRESS GARDEN LN
Practice Address - Street 2:
Practice Address - City:FORNEY
Practice Address - State:TX
Practice Address - Zip Code:75126-3756
Practice Address - Country:US
Practice Address - Phone:240-702-4667
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-27
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant