Samuel Adewale Ogunsola

Key facts

NPI

1104935907

Entity type

Individual (NPI type 1)

Primary specialty

Nuclear Medicine Technology Radiologic Technologist 2471N0900X

License

27340 (TX)

Practice address

2002 Holcombe Blvd
Houston, TX 77030-4211

Phone

(713) 794-7079

NPI assigned

Aug 29, 2006

Sex

Male

Sole proprietor

No

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

No

State licenses

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jul 8, 2007.

{
    "created_epoch": "1156809600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1104935907",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2002 HOLCOMBE BLVD",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770304211",
            "telephone_number": "713-794-7079"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2002 HOLCOMBE BLVD",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770304211",
            "telephone_number": "713-794-7079"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OGUNSOLA",
        "first_name": "SAMUEL",
        "middle_name": "ADEWALE",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-29",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2471N0900X",
            "taxonomy_group": "",
            "desc": "Radiologic Technologist, Nuclear Medicine Technology",
            "state": "TX",
            "license": "27340",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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All providers in Houston, TX · Nuclear Medicine Technology Radiologic Technologist in Texas