Provider Demographics
NPI:1548748551
Name:JAIYESIMI, JOSHUA OLUWASEGUN (LVN)
Entity type:Individual
Prefix:MR
First Name:JOSHUA
Middle Name:OLUWASEGUN
Last Name:JAIYESIMI
Suffix:
Gender:M
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3505 W SAM HOUSTON PKWY S APT 1313
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77042-2089
Mailing Address - Country:US
Mailing Address - Phone:786-326-0535
Mailing Address - Fax:
Practice Address - Street 1:11929 UNIVERSITY BLVD STE 2M
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-4757
Practice Address - Country:US
Practice Address - Phone:281-238-8775
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-01
Last Update Date:2018-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX321913164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse