Provider Demographics
NPI:1336411271
Name:LIASU, OLATUNJI Y
Entity Type:Individual
Prefix:MR
First Name:OLATUNJI
Middle Name:Y
Last Name:LIASU
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 1:3928 SUITLAND RD APT 101
Mailing Address - Street 2:
Mailing Address - City:SUITLAND
Mailing Address - State:MD
Mailing Address - Zip Code:20746-1926
Mailing Address - Country:US
Mailing Address - Phone:240-421-3607
Mailing Address - Fax:
Practice Address - Street 1:3928 SUITLAND RD APT 101
Practice Address - Street 2:
Practice Address - City:SUITLAND
Practice Address - State:MD
Practice Address - Zip Code:20746-1926
Practice Address - Country:US
Practice Address - Phone:240-421-3607
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-08
Last Update Date:2012-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide