Healthcare Provider Details

I. General information

NPI: 1487998050
Provider Name (Legal Business Name): OMOLOLA OGUNSESIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/20/2012
Last Update Date: 11/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

439 ONEIDA PL NW
WASHINGTON DC
20011-2150
US

IV. Provider business mailing address

9119 SPRINGHILL LN APT # 301
GREENBELT MD
20770-1216
US

V. Phone/Fax

Practice location:
  • Phone: 202-291-7226
  • Fax: 202-291-4009
Mailing address:
  • Phone: 267-423-7774
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: