Provider Demographics
NPI:1104461888
Name:TIJANI, ABDULRAHMAN O
Entity type:Individual
Prefix:
First Name:ABDULRAHMAN
Middle Name:O
Last Name:TIJANI
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 1:25 42ND ST NE APT 201
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20019-4573
Mailing Address - Country:US
Mailing Address - Phone:240-353-9741
Mailing Address - Fax:
Practice Address - Street 1:25 42ND ST NE APT 201
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20019-4573
Practice Address - Country:US
Practice Address - Phone:240-353-9741
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-17
Last Update Date:2019-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC20019Medicaid
DC20019Other20019