Basic Information
| Provider Information | |||||||||
| NPI: | 1376146969 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ADEBANJO | ||||||||
| FirstName: | OLUBUKOLA | ||||||||
| MiddleName: | ESTHER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5315 GIBRALTER PL | ||||||||
| Address2: | |||||||||
| City: | RICHMOND | ||||||||
| State: | TX | ||||||||
| PostalCode: | 774074187 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8326779095 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2424 WILCREST DR STE 110 | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770422772 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7136668287 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/17/2020 | ||||||||
| LastUpdateDate: | 11/17/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/17/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 972887 | TX | Y | Nursing Service Providers | Registered Nurse |
No ID Information.