Provider Demographics
NPI:1770351462
Name:ILUPEJU, FAOSIAT OMOLARA
Entity type:Individual
Prefix:
First Name:FAOSIAT
Middle Name:OMOLARA
Last Name:ILUPEJU
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 1:3501 LOTTSFORD VISTA RD
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20721-4012
Mailing Address - Country:US
Mailing Address - Phone:202-459-8469
Mailing Address - Fax:
Practice Address - Street 1:3501 LOTTSFORD VISTA RD
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20721-4012
Practice Address - Country:US
Practice Address - Phone:202-459-8469
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-13
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant