Healthcare Provider Details

I. General information

NPI: 1487995197
Provider Name (Legal Business Name): MR. AUGUSTINE AGBOOLA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/05/2013
Last Update Date: 03/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6856 EASTERN AVE NW SUITE 350
WASHINGTON DC
20012-2165
US

IV. Provider business mailing address

13243 STRAVINSKY TER
SILVER SPRING MD
20904-6840
US

V. Phone/Fax

Practice location:
  • Phone: 202-545-0211
  • 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: