Healthcare Provider Details

I. General information

NPI: 1083960298
Provider Name (Legal Business Name): AYODEJI OLOBATUYI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2012
Last Update Date: 07/28/2023
Certification Date: 07/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

313 8TH ST NE
WASHINGTON DC
20002-6107
US

IV. Provider business mailing address

4308 CONCEPT CT
LANHAM MD
20706-1900
US

V. Phone/Fax

Practice location:
  • Phone: 202-544-8211
  • Fax: 202-544-8216
Mailing address:
  • Phone: 202-544-8211
  • Fax: 202-544-8216

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateDC
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: