Individual
OMOLAYO KOLLEADE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3352 SEDONA DR, GRAND PRAIRIE, TX 75052-8401
(214) 986-4598
(972) 522-0838
Mailing address
3352 SEDONA DR, GRAND PRAIRIE, TX 75052-8401
(214) 986-4598
(972) 522-0838
Taxonomy
Speciality
Code
Description
License number
State
372600000X
Adult Companion
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
47-2025644
—
TX
01
—
NEW BUSINESS
NEW BUSINESS
—
Enumeration date
04/09/2015
Last updated
04/09/2015
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