Healthcare Provider Details

I. General information

NPI: 1891380168
Provider Name (Legal Business Name): LATIFAT OGUNWEMIMO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2021
Last Update Date: 04/11/2024
Certification Date: 04/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9319 HOBART ST
SPRINGDALE MD
20774-5413
US

IV. Provider business mailing address

9319 HOBART ST
SPRINGDALE MD
20774-5413
US

V. Phone/Fax

Practice location:
  • Phone: 240-988-7859
  • Fax: 410-946-2010
Mailing address:
  • Phone: 240-988-7859
  • Fax: 410-946-2010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License NumberHHA200002122
License Number StateDC
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: