Provider Demographics
NPI:1679327258
Name:OJASOPE, OLA
Entity type:Individual
Prefix:MR
First Name:OLA
Middle Name:
Last Name:OJASOPE
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 1:752 E MEGAN ST
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85225-3955
Mailing Address - Country:US
Mailing Address - Phone:480-242-4551
Mailing Address - Fax:480-590-2595
Practice Address - Street 1:752 E MEGAN ST
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85225-3955
Practice Address - Country:US
Practice Address - Phone:480-242-4551
Practice Address - Fax:480-590-2595
Is Sole Proprietor?:No
Enumeration Date:2024-04-11
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAL11202H374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide