Healthcare Provider Details

I. General information

NPI: 1104187921
Provider Name (Legal Business Name): OLABIYI A TUBI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/07/2012
Last Update Date: 08/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1818 NEW YORK AVE NE 228
WASHINGTON DC
20002
US

IV. Provider business mailing address

8511 GREENBELT RD APT 101
GREENBELT MD
20770-2308
US

V. Phone/Fax

Practice location:
  • Phone: 202-832-8340
  • Fax:
Mailing address:
  • Phone: 240-486-6623
  • Fax:

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: