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General NPI Number Information
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NPI Number | 1598115438
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Entity Type | Individual
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Provider Name | OWOKUNILE OTUBUSIN M.D.
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Gender | Female
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Dates
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Enumeration Date | 06/21/2016
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Last Update Date | 06/21/2016
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Provider Practice Location Address
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Address Line | 1100 ALABAMA AVE SE 2ND FLOOR, ROOM 238
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City | WASHINGTON
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State | DC
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Zip | 20032-4540
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Country | US
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Telephone | 202-299-5397
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Fax |
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Provider Business Mailing Address
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Address Line | 5404 AUTH RD APT 310
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City | CAMP SPRINGS
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State | MD
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Zip | 20746-4358
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Country | US
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Telephone | 832-512-5923
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Fax |
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | MTL003887
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License Number State | DC
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