Provider Demographics
NPI:1326857806
Name:ODUTOLA, HAROLD (PA)
Entity type:Individual
Prefix:MR
First Name:HAROLD
Middle Name:
Last Name:ODUTOLA
Suffix:
Gender:M
Credentials:PA
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Mailing Address - Street 1:1136 E HARMONY AVE STE 202B-2
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85204-5844
Mailing Address - Country:US
Mailing Address - Phone:407-738-5791
Mailing Address - Fax:480-210-3563
Practice Address - Street 1:1136 E HARMONY AVE STE 202B-2
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85204-5844
Practice Address - Country:US
Practice Address - Phone:407-738-5791
Practice Address - Fax:480-210-3563
Is Sole Proprietor?:No
Enumeration Date:2024-12-30
Last Update Date:2025-01-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR002426-P.A.363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant