Healthcare Provider Details

I. General information

NPI: 1316292311
Provider Name (Legal Business Name): FRANCIS OGUNDOKUN HHA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2012
Last Update Date: 07/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9503 TIBERIAS DR
UPPER MARLBORO MD
20772-5412
US

IV. Provider business mailing address

9503 TIBERIAS DR
UPPER MARLBORO MD
20772-5412
US

V. Phone/Fax

Practice location:
  • Phone: 202-545-0935
  • Fax: 202-545-0934
Mailing address:
  • Phone: 202-545-0935
  • Fax: 202-545-0934

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: