Provider Demographics
NPI:1487111019
Name:WAITAY, RUGIATU E
Entity type:Individual
Prefix:
First Name:RUGIATU
Middle Name:E
Last Name:WAITAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 COTTMAN AVE APT B11512
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19111-3056
Mailing Address - Country:US
Mailing Address - Phone:215-436-0554
Mailing Address - Fax:267-339-6111
Practice Address - Street 1:800 COTTMAN AVE APT B11512
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19111-3056
Practice Address - Country:US
Practice Address - Phone:215-436-0554
Practice Address - Fax:267-339-6111
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-01
Last Update Date:2019-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA39613601251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health