Provider Demographics
NPI:1659986941
Name:GOITAOM, OGBAMICAEL G (INTERPRETER)
Entity Type:Individual
Prefix:MR
First Name:OGBAMICAEL
Middle Name:G
Last Name:GOITAOM
Suffix:
Gender:M
Credentials:INTERPRETER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15140 65TH AVE S APT 217
Mailing Address - Street 2:
Mailing Address - City:TUKWILA
Mailing Address - State:WA
Mailing Address - Zip Code:98188-2515
Mailing Address - Country:US
Mailing Address - Phone:206-331-5951
Mailing Address - Fax:
Practice Address - Street 1:15140 65TH AVE S APT 217
Practice Address - Street 2:
Practice Address - City:TUKWILA
Practice Address - State:WA
Practice Address - Zip Code:98188-2515
Practice Address - Country:US
Practice Address - Phone:206-331-5951
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-13
Last Update Date:2020-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA603141094171R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171R00000XOther Service ProvidersInterpreter