Healthcare Provider Details

I. General information

NPI: 1497097489
Provider Name (Legal Business Name): OLUWAFEMI FAGBUYI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/18/2013
Last Update Date: 02/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

143 KENNEDY ST NW STE 3
WASHINGTON DC
20011-5270
US

IV. Provider business mailing address

143 KENNEDY ST NW STE 3
WASHINGTON DC
20011-5270
US

V. Phone/Fax

Practice location:
  • Phone: 202-450-4122
  • Fax: 202-450-4123
Mailing address:
  • Phone: 202-450-4122
  • Fax: 202-450-4123

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: