Provider Demographics
NPI:1689401770
Name:BOLARINWA, ISIAKA AJEWALE
Entity type:Individual
Prefix:
First Name:ISIAKA
Middle Name:AJEWALE
Last Name:BOLARINWA
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 1:174 PINECOVE AVE
Mailing Address - Street 2:
Mailing Address - City:ODENTON
Mailing Address - State:MD
Mailing Address - Zip Code:21113-2606
Mailing Address - Country:US
Mailing Address - Phone:240-334-8902
Mailing Address - Fax:
Practice Address - Street 1:174 PINECOVE AVE
Practice Address - Street 2:
Practice Address - City:ODENTON
Practice Address - State:MD
Practice Address - Zip Code:21113-2606
Practice Address - Country:US
Practice Address - Phone:240-334-8902
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-13
Last Update Date:2024-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
10000-407374700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374700000XNursing Service Related ProvidersTechnician