Healthcare Provider Details

I. General information

NPI: 1013270826
Provider Name (Legal Business Name): MS. ENIOLA A OLORUNTOBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2012
Last Update Date: 06/18/2012
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

4215 58TH AVE #4
BLADENSBURG MD
20710-1943
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: