Healthcare Provider Details

I. General information

NPI: 1306142393
Provider Name (Legal Business Name): FLORENCE OGUNLESI R.D, L.D.N
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/08/2011
Last Update Date: 02/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10035 CORIOLI WAY
OWINGS MILLS MD
21117-4068
US

IV. Provider business mailing address

10035 CORIOLI WAY
OWINGS MILLS MD
21117-4068
US

V. Phone/Fax

Practice location:
  • Phone: 301-792-0547
  • Fax: 410-205-7584
Mailing address:
  • Phone: 301-792-0547
  • Fax: 410-205-7584

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDX2923
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: