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General NPI Number Information
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NPI Number | 1073208351
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Entity Type | Individual
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Provider Name | AKINTUNDE GANIYU OMISANMI SR.
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Gender | Male
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Dates
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Enumeration Date | 04/11/2023
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Last Update Date | 10/24/2023
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Provider Practice Location Address
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Address Line | 915 RHODE ISLAND AVENUE, SE
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City | WASHINGTON
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State | DC
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Zip | 20001
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Country | US
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Telephone | 301-232-6100
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Fax | 202-750-7383
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Provider Business Mailing Address
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Address Line | 807 ALABASTER CT
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City | CAPITOL HEIGHTS
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State | MD
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Zip | 20743-1872
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Country | US
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Telephone | 240-353-2171
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Fax | 202-750-7383
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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