Provider Demographics
NPI:1407250509
Name:ONAMUTI, IYABODE
Entity Type:Individual
Prefix:
First Name:IYABODE
Middle Name:
Last Name:ONAMUTI
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 1:9116 CENTER ST STE 207
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20110-5460
Mailing Address - Country:US
Mailing Address - Phone:571-292-1461
Mailing Address - Fax:571-292-2196
Practice Address - Street 1:9116 CENTER ST STE 207
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20110-5460
Practice Address - Country:US
Practice Address - Phone:571-292-1461
Practice Address - Fax:571-292-2196
Is Sole Proprietor?:No
Enumeration Date:2014-10-17
Last Update Date:2014-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAHCO-149183747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant