Healthcare Provider Details

I. General information

NPI: 1932447109
Provider Name (Legal Business Name): TITILAYO O ORIMOGUNJE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/23/2013
Last Update Date: 07/02/2024
Certification Date: 07/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3800 RESERVOIR RD NW
WASHINGTON DC
20007-2113
US

IV. Provider business mailing address

3800 RESERVOIR RD NW
WASHINGTON DC
20007-2113
US

V. Phone/Fax

Practice location:
  • Phone: 202-444-3700
  • Fax: 202-444-3760
Mailing address:
  • Phone: 202-444-3700
  • Fax: 202-444-3760

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN963005
License Number StateDC
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberRN963005
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: