Provider Demographics
NPI:1033760517
Name:OJO, MATTHEW ABIOLA (RN)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:ABIOLA
Last Name:OJO
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 JUNIPER RIDGE BLVD APT 147
Mailing Address - Street 2:
Mailing Address - City:COALINGA
Mailing Address - State:CA
Mailing Address - Zip Code:93210-9275
Mailing Address - Country:US
Mailing Address - Phone:678-637-1862
Mailing Address - Fax:
Practice Address - Street 1:300 JUNIPER RIDGE BLVD APT 147
Practice Address - Street 2:
Practice Address - City:COALINGA
Practice Address - State:CA
Practice Address - Zip Code:93210-9275
Practice Address - Country:US
Practice Address - Phone:678-637-1862
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-25
Last Update Date:2019-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA690941163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty