Provider Demographics
NPI:1194416271
Name:OYEWALE, OYENIRAN
Entity type:Individual
Prefix:
First Name:OYENIRAN
Middle Name:
Last Name:OYEWALE
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 1:12 CARRIAGE WAY
Mailing Address - Street 2:
Mailing Address - City:NORTH PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02904-3002
Mailing Address - Country:US
Mailing Address - Phone:401-527-2964
Mailing Address - Fax:
Practice Address - Street 1:12 CARRIAGE WAY
Practice Address - Street 2:
Practice Address - City:NORTH PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02904-3002
Practice Address - Country:US
Practice Address - Phone:401-527-2964
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-18
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)