Provider Demographics
NPI:1770357709
Name:OMOJOLA, OMOLARA
Entity type:Individual
Prefix:
First Name:OMOLARA
Middle Name:
Last Name:OMOJOLA
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 1:618 ELLWOOD TERRACE LN
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77406-3080
Mailing Address - Country:US
Mailing Address - Phone:301-531-0009
Mailing Address - Fax:
Practice Address - Street 1:618 ELLWOOD TERRACE LN
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77406-3080
Practice Address - Country:US
Practice Address - Phone:301-531-0009
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-09
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle
No343800000XTransportation ServicesSecured Medical Transport (VAN)
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)