Provider Demographics
NPI:1689171217
Name:SERIKI, OPETOMI OMORINSOLA (DO)
Entity Type:Individual
Prefix:DR
First Name:OPETOMI
Middle Name:OMORINSOLA
Last Name:SERIKI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:803 PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:KENNEDALE
Mailing Address - State:TX
Mailing Address - Zip Code:76060-5605
Mailing Address - Country:US
Mailing Address - Phone:817-821-0579
Mailing Address - Fax:
Practice Address - Street 1:8109 TIS WELL DRIVE
Practice Address - Street 2:SUITE 511
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22306
Practice Address - Country:US
Practice Address - Phone:703-779-9500
Practice Address - Fax:703-779-9502
Is Sole Proprietor?:No
Enumeration Date:2018-04-10
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
VA0102207980207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program