Provider Demographics
NPI:1548154065
Name:FALADE, OLUMYIWA ADEBAMIJI
Entity type:Individual
Prefix:
First Name:OLUMYIWA
Middle Name:ADEBAMIJI
Last Name:FALADE
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 1:2130 ENCHANTED PARK LN
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77450-7126
Mailing Address - Country:US
Mailing Address - Phone:281-660-3454
Mailing Address - Fax:
Practice Address - Street 1:2130 ENCHANTED PARK LN
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77450-7126
Practice Address - Country:US
Practice Address - Phone:281-660-3454
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-07
Last Update Date:2025-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty