Organization
OLAOLU INCORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LORI LABRECQUE (ACCOUNTS MANAGER)
(702) 453-3799
Entity
Organization
Contact information
Practice address
10301 JEFFREYS ST, HENDERSON, NV 89052-3922
(702) 453-3799
(702) 453-5741
Mailing address
PO BOX 81452, LAS VEGAS, NV 89180-1452
(702) 453-3799
(702) 453-5741
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
—
—
208M00000X
Hospitalist Physician
Primary
MD60329818
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
14674
NV LICENSE
NV
01
—
MD60329818
WA LIC
WA
Enumeration date
05/23/2013
Last updated
11/13/2018
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