Healthcare Provider Details

I. General information

NPI: 1821806886
Provider Name (Legal Business Name): ORIRE O BALOGUN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/23/2024
Last Update Date: 12/23/2024
Certification Date: 12/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2512 24TH ST NE
WASHINGTON DC
20018-2126
US

IV. Provider business mailing address

3406 DODGE PARK RD APT 203
HYATTSVILLE MD
20785-2015
US

V. Phone/Fax

Practice location:
  • Phone: 408-348-5255
  • Fax:
Mailing address:
  • Phone: 240-665-9994
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License NumberHHA200003687
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: