Provider Demographics
NPI:1881957801
Name:FATUNBI, ADESOLA IDIAT
Entity type:Individual
Prefix:
First Name:ADESOLA
Middle Name:IDIAT
Last Name:FATUNBI
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 1:6717 RIVERDALE RD
Mailing Address - Street 2:#B
Mailing Address - City:RIVERDALE
Mailing Address - State:MD
Mailing Address - Zip Code:20737-1750
Mailing Address - Country:US
Mailing Address - Phone:202-294-6790
Mailing Address - Fax:
Practice Address - Street 1:6717 RIVERDALE RD
Practice Address - Street 2:#B
Practice Address - City:RIVERDALE
Practice Address - State:MD
Practice Address - Zip Code:20737-1750
Practice Address - Country:US
Practice Address - Phone:202-294-6790
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-25
Last Update Date:2012-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide