Provider Demographics
NPI:1801640354
Name:OWATEMI, AYORINDE
Entity type:Individual
Prefix:
First Name:AYORINDE
Middle Name:
Last Name:OWATEMI
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 1:1059 TREMONT ST STE 2
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02120-2193
Mailing Address - Country:US
Mailing Address - Phone:857-234-3552
Mailing Address - Fax:857-437-5071
Practice Address - Street 1:1059 TREMONT ST STE 2
Practice Address - Street 2:
Practice Address - City:ROXBURY
Practice Address - State:MA
Practice Address - Zip Code:02120-2193
Practice Address - Country:US
Practice Address - Phone:857-234-3552
Practice Address - Fax:857-437-5071
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-12
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator