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Organization
ICONIC HEALTHCARE SERVICES CO.
Active
Organization
ICONIC HEALTHCARE SERVICES CO.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. WILFRED USI AJAYI MD., PHD. (PRESIDENT/CEO)
(281) 901-8950
Entity
Organization
Contact information
Practice address
17045 EL CAMINO REAL STE 218, HOUSTON, TX 77058-2644
(281) 461-4000
(281) 204-9040
Mailing address
17045 EL CAMINO REAL, SUITE 218, HOUSTON, TX 77058
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
289023801
—
TX
Enumeration date
07/09/2010
Last updated
08/07/2012
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