Provider Demographics
NPI:1003289067
Name:OLOKO, OLAYIWOLA O
Entity Type:Individual
Prefix:
First Name:OLAYIWOLA
Middle Name:O
Last Name:OLOKO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19300 CIRCLE GATE DR #201
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20874
Mailing Address - Country:US
Mailing Address - Phone:202-631-7206
Mailing Address - Fax:
Practice Address - Street 1:19300 CIRCLE GATE DR #201
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:MD
Practice Address - Zip Code:20874
Practice Address - Country:US
Practice Address - Phone:202-631-7206
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-12
Last Update Date:2015-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide