Healthcare Provider Details

I. General information

NPI: 1124754635
Provider Name (Legal Business Name): ERIC ONYEGBULA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2022
Last Update Date: 07/27/2022
Certification Date: 07/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5513 ILLINOIS AVE NW
WASHINGTON DC
20011-2937
US

IV. Provider business mailing address

7704 GARRISON RD
HYATTSVILLE MD
20784-1727
US

V. Phone/Fax

Practice location:
  • Phone: 202-882-9310
  • Fax:
Mailing address:
  • Phone: 347-744-4219
  • 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: