Provider Demographics
NPI:1730859737
Name:OJAGUE, STANLEY EFFIM
Entity type:Individual
Prefix:
First Name:STANLEY
Middle Name:EFFIM
Last Name:OJAGUE
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 1:3600 40TH PL
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:MD
Mailing Address - Zip Code:20722-2114
Mailing Address - Country:US
Mailing Address - Phone:202-940-3606
Mailing Address - Fax:
Practice Address - Street 1:3600 40TH PL
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:MD
Practice Address - Zip Code:20722-2114
Practice Address - Country:US
Practice Address - Phone:202-940-3606
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-20
Last Update Date:2021-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDCNA20213169374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide