Provider Demographics
NPI:1174916118
Name:OYINBOADE, RASAQ OLAITAN
Entity type:Individual
Prefix:MR
First Name:RASAQ
Middle Name:OLAITAN
Last Name:OYINBOADE
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 1:80 COGSWELL ST UNIT 1
Mailing Address - Street 2:C17
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06610-1945
Mailing Address - Country:US
Mailing Address - Phone:203-993-5083
Mailing Address - Fax:
Practice Address - Street 1:80 COGSWELL ST UNIT 1
Practice Address - Street 2:C17
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06610-1945
Practice Address - Country:US
Practice Address - Phone:203-993-5083
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-16
Last Update Date:2015-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide