Provider Demographics
NPI:1982420055
Name:OGUNTADE, OLUWATOSIN VICTORIA
Entity type:Individual
Prefix:
First Name:OLUWATOSIN
Middle Name:VICTORIA
Last Name:OGUNTADE
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 1:2207 LITTLE TREE BND
Mailing Address - Street 2:
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78613-1529
Mailing Address - Country:US
Mailing Address - Phone:945-249-2788
Mailing Address - Fax:
Practice Address - Street 1:2207 LITTLE TREE BND
Practice Address - Street 2:
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-1529
Practice Address - Country:US
Practice Address - Phone:945-249-2788
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-23
Last Update Date:2024-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1118181163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse