Healthcare Provider Details

I. General information

NPI: 1285098988
Provider Name (Legal Business Name): AUGUSTINE OPARA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2016
Last Update Date: 04/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6303 RORY CT
LANHAM MD
20706-2478
US

IV. Provider business mailing address

6303 RORY CT
LANHAM MD
20706-2478
US

V. Phone/Fax

Practice location:
  • Phone: 240-988-7801
  • Fax:
Mailing address:
  • Phone: 240-988-7801
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License NumberHHA11875
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: