Provider Demographics
NPI:1043046485
Name:ADEJUMOBI, OLAYIDE ADEOLA (RD)
Entity type:Individual
Prefix:MRS
First Name:OLAYIDE
Middle Name:ADEOLA
Last Name:ADEJUMOBI
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1250 RAINIER DR
Mailing Address - Street 2:
Mailing Address - City:PROSPER
Mailing Address - State:TX
Mailing Address - Zip Code:75078-7092
Mailing Address - Country:US
Mailing Address - Phone:806-281-2655
Mailing Address - Fax:
Practice Address - Street 1:1250 RAINIER DR
Practice Address - Street 2:
Practice Address - City:PROSPER
Practice Address - State:TX
Practice Address - Zip Code:75078-7092
Practice Address - Country:US
Practice Address - Phone:806-281-2655
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-11
Last Update Date:2024-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT84523133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered