Healthcare Provider Details

I. General information

NPI: 1285047852
Provider Name (Legal Business Name): JOHN OGUNLOWO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2014
Last Update Date: 06/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4825 N CAPITOL ST NE
WASHINGTON DC
20011-6747
US

IV. Provider business mailing address

4825 N CAPITOL ST NE
WASHINGTON DC
20011-6747
US

V. Phone/Fax

Practice location:
  • Phone: 202-344-7796
  • Fax:
Mailing address:
  • Phone:
  • 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: