Provider Demographics
NPI:1568860211
Name:OGUNDIMINEGHA, OLUBUNMI
Entity Type:Individual
Prefix:
First Name:OLUBUNMI
Middle Name:
Last Name:OGUNDIMINEGHA
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 1:5621 CHAMPIONS DR
Mailing Address - Street 2:
Mailing Address - City:PACE
Mailing Address - State:FL
Mailing Address - Zip Code:32571-8417
Mailing Address - Country:US
Mailing Address - Phone:774-253-4035
Mailing Address - Fax:
Practice Address - Street 1:5621 CHAMPIONS DR
Practice Address - Street 2:
Practice Address - City:PACE
Practice Address - State:FL
Practice Address - Zip Code:32571-8417
Practice Address - Country:US
Practice Address - Phone:774-253-4035
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-11
Last Update Date:2014-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion