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General NPI Number Information
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NPI Number | 1689171217
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Entity Type | Individual
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Provider Name | OPETOMI OMORINSOLA SERIKI DO
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Gender | Female
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Dates
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Enumeration Date | 04/10/2018
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Last Update Date | 09/20/2023
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Provider Practice Location Address
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Address Line | 8109 TIS WELL DRIVE SUITE 511
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City | ALEXANDRIA
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State | VA
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Zip | 22306
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Country | US
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Telephone | 703-779-9500
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Fax | 703-779-9502
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Provider Business Mailing Address
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Address Line | 803 PENNSYLVANIA AVE
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City | KENNEDALE
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State | TX
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Zip | 76060-5605
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Country | US
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Telephone | 817-821-0579
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 0102207980
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License Number State | VA
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