Provider Demographics
NPI:1104265818
Name:EMIOLA, RAUF BOLADALE (PMHNP)
Entity type:Individual
Prefix:
First Name:RAUF
Middle Name:BOLADALE
Last Name:EMIOLA
Suffix:
Gender:M
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11122 MINERAL ISLAND LN
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77406-1681
Mailing Address - Country:US
Mailing Address - Phone:832-876-3626
Mailing Address - Fax:
Practice Address - Street 1:11122 MINERAL ISLAND LN
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77406-1681
Practice Address - Country:US
Practice Address - Phone:832-876-3626
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-17
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP123408363LF0000X, 363LP0808X
TX751577363LF0000X
WAAP61552322363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily