Provider Demographics
NPI:1215111745
Name:OLATAYO, ASIMIYU OLADAYO
Entity type:Individual
Prefix:MR
First Name:ASIMIYU
Middle Name:OLADAYO
Last Name:OLATAYO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8700 COMMERCE PARK DR
Mailing Address - Street 2:SUITE 119
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77036-7497
Mailing Address - Country:US
Mailing Address - Phone:832-807-1450
Mailing Address - Fax:
Practice Address - Street 1:8700 COMMERCE PARK DR
Practice Address - Street 2:SUITE 119
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77036-7497
Practice Address - Country:US
Practice Address - Phone:832-807-1450
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-19
Last Update Date:2016-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0104173747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant