Provider Demographics
NPI:1194767442
Name:OYENUGA, ADESHOLA AJOKE
Entity type:Individual
Prefix:MRS
First Name:ADESHOLA
Middle Name:AJOKE
Last Name:OYENUGA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:811 S CENTRAL EXPY
Mailing Address - Street 2:SUITE 536
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080-7415
Mailing Address - Country:US
Mailing Address - Phone:972-235-8383
Mailing Address - Fax:972-235-8384
Practice Address - Street 1:811 S CENTRAL EXPY
Practice Address - Street 2:SUITE 536
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-7415
Practice Address - Country:US
Practice Address - Phone:972-235-8383
Practice Address - Fax:972-235-8384
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX00835571744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX5565420001Medicare NSC