Healthcare Provider Details

I. General information

NPI: 1073839205
Provider Name (Legal Business Name): OLATUNDE OGUNYEMI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2010
Last Update Date: 04/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 K ST NE
WASHINGTON DC
20002-4216
US

IV. Provider business mailing address

35 K ST NE
WASHINGTON DC
20002-4216
US

V. Phone/Fax

Practice location:
  • Phone: 202-442-4202
  • Fax: 202-727-0857
Mailing address:
  • Phone: 202-442-4202
  • Fax: 202-727-0857

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLC302887
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: