Healthcare Provider Details

I. General information

NPI: 1407119167
Provider Name (Legal Business Name): MR. JULIUS OGUNTAYO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2012
Last Update Date: 06/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

945 WESTLAKE DR
BOWIE MD
20721-1851
US

IV. Provider business mailing address

945 WESTLAKE DR
BOWIE MD
20721-1851
US

V. Phone/Fax

Practice location:
  • Phone: 301-357-1538
  • 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 StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: