Provider Demographics
NPI:1225848526
Name:AYOOLA, JOSEPH OLAOLUWA
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:OLAOLUWA
Last Name:AYOOLA
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 1:4818 MARIGOLD BREEZE DR # TX
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77386-5002
Mailing Address - Country:US
Mailing Address - Phone:347-419-5776
Mailing Address - Fax:
Practice Address - Street 1:15911 VISTA DEL MAR DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77083-2345
Practice Address - Country:US
Practice Address - Phone:347-419-5776
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-09
Last Update Date:2025-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2024073348363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health