Healthcare Provider Details

I. General information

NPI: 1558637876
Provider Name (Legal Business Name): AYODEJI ODUJINRIN RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2012
Last Update Date: 03/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1707 L ST NW SUITE 900
WASHINGTON DC
20036-4201
US

IV. Provider business mailing address

1012 HEARTFIELDS DR
SILVER SPRING MD
20904-2114
US

V. Phone/Fax

Practice location:
  • Phone: 202-829-1111
  • Fax:
Mailing address:
  • Phone: 240-372-6978
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN65160
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: