Provider Demographics
NPI:1306142393
Name:OGUNLESI, FLORENCE (RD, LDN)
Entity type:Individual
Prefix:
First Name:FLORENCE
Middle Name:
Last Name:OGUNLESI
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10035 CORIOLI WAY
Mailing Address - Street 2:
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-4068
Mailing Address - Country:US
Mailing Address - Phone:301-792-0547
Mailing Address - Fax:410-205-7584
Practice Address - Street 1:10035 CORIOLI WAY
Practice Address - Street 2:
Practice Address - City:OWINGS MILLS
Practice Address - State:MD
Practice Address - Zip Code:21117-4068
Practice Address - Country:US
Practice Address - Phone:301-792-0547
Practice Address - Fax:410-205-7584
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-08
Last Update Date:2011-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDDX2923133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
12185907OtherCAQH