Individual
BABAJIDE OMOTAYO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
10300 S WILCREST DR, #309, HOUSTON, TX 77099-2867
(409) 499-3796
Mailing address
PO BOX 720715, HOUSTON, TX 77272-0715
(409) 499-3796
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
226313
TX
Other
Enumeration date
06/15/2011
Last updated
09/11/2012
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