Provider Demographics
NPI:1336897008
Name:OHAYA, CAJETAN ANAYO (PROVIDER)
Entity Type:Individual
Prefix:MR
First Name:CAJETAN
Middle Name:ANAYO
Last Name:OHAYA
Suffix:
Gender:M
Credentials:PROVIDER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 COREY AVE
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301-1558
Mailing Address - Country:US
Mailing Address - Phone:617-775-1568
Mailing Address - Fax:
Practice Address - Street 1:10 COREY AVE
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-1558
Practice Address - Country:US
Practice Address - Phone:617-775-1568
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-12
Last Update Date:2022-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALN89332164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse