Provider Demographics
NPI:1144581604
Name:MARTINS, OMOTOLA A
Entity Type:Individual
Prefix:
First Name:OMOTOLA
Middle Name:A
Last Name:MARTINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5902 31ST AVE
Mailing Address - Street 2:APT. # 514
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20782-2947
Mailing Address - Country:US
Mailing Address - Phone:202-489-7027
Mailing Address - Fax:
Practice Address - Street 1:5902 31ST AVE
Practice Address - Street 2:APT. # 514
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20782-2947
Practice Address - Country:US
Practice Address - Phone:202-489-7027
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-31
Last Update Date:2012-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide