Basic Information
| Provider Information | |||||||||
| NPI: | 1114423225 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | OSO | ||||||||
| FirstName: | ABIOLA | ||||||||
| MiddleName: | AYOBAMIJI | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9452 LONDON BRIDGE STA | ||||||||
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| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770454643 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6786435321 | ||||||||
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| Practice Location | |||||||||
| Address1: | 6431 FANNIN ST | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770301501 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7135007878 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/05/2018 | ||||||||
| LastUpdateDate: | 08/10/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 08/10/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207P00000X | S7928 | TX | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.