Provider Demographics
NPI:1265254502
Name:OTUBAGA, MOLAYO
Entity type:Individual
Prefix:
First Name:MOLAYO
Middle Name:
Last Name:OTUBAGA
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 1:12475 WOOD FOREST DR APT 1404
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77013-6124
Mailing Address - Country:US
Mailing Address - Phone:832-638-3142
Mailing Address - Fax:
Practice Address - Street 1:814 SHELDON RD
Practice Address - Street 2:
Practice Address - City:CHANNELVIEW
Practice Address - State:TX
Practice Address - Zip Code:77530-3512
Practice Address - Country:US
Practice Address - Phone:281-452-7184
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-28
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program