Provider Demographics
NPI:1376054585
Name:OLAIYA, ABIMBOLA OLUDARE
Entity Type:Individual
Prefix:
First Name:ABIMBOLA
Middle Name:OLUDARE
Last Name:OLAIYA
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 1:7741 RIVERDALE RD
Mailing Address - Street 2:
Mailing Address - City:NEW CARROLLTON
Mailing Address - State:MD
Mailing Address - Zip Code:20784-3911
Mailing Address - Country:US
Mailing Address - Phone:240-413-8089
Mailing Address - Fax:
Practice Address - Street 1:7741 RIVERDALE RD
Practice Address - Street 2:
Practice Address - City:NEW CARROLLTON
Practice Address - State:MD
Practice Address - Zip Code:20784-3911
Practice Address - Country:US
Practice Address - Phone:240-413-8089
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-14
Last Update Date:2017-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA13206374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide