Individual
MISS LATEEFAT OMOLARA FAGBENRO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3318 DODGE PARK RD APT 101, LANDOVER, MD 20785-2114
(240) 413-1823
Mailing address
3318 DODGE PARK RD APT 101, LANDOVER, MD 20785-2114
(240) 413-1823
Taxonomy
Speciality
Code
Description
License number
State
374U00000X
Home Health Aide
Primary
HHA11333
DC
390200000X
Student in an Organized Health Care Education/Training Program
NA00809491
MD
Other
Enumeration date
07/14/2015
Last updated
03/14/2018
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