Provider Demographics
NPI:1689402679
Name:CLINIVA PRIMARY CARE, LLC
Entity type:Organization
Organization Name:CLINIVA PRIMARY CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ADEJOKE
Authorized Official - Middle Name:
Authorized Official - Last Name:SIJUWADE
Authorized Official - Suffix:
Authorized Official - Credentials:CRNP
Authorized Official - Phone:240-931-0658
Mailing Address - Street 1:5999 HARPERS FARM RD STE W230
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-3025
Mailing Address - Country:US
Mailing Address - Phone:240-931-0658
Mailing Address - Fax:240-732-0240
Practice Address - Street 1:5999 HARPERS FARM RD STE W230
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-3025
Practice Address - Country:US
Practice Address - Phone:240-931-0658
Practice Address - Fax:240-732-0240
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-23
Last Update Date:2024-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty