Healthcare Provider Details

I. General information

NPI: 1508016064
Provider Name (Legal Business Name): MATTHEW ADELEKE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2008
Last Update Date: 09/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 N CENTRAL AVENUE
COMPTON CA
90220
US

IV. Provider business mailing address

209 N CENTRAL AVENUE
COMPTON CA
90220-1425
US

V. Phone/Fax

Practice location:
  • Phone: 310-639-1907
  • Fax: 310-999-6568
Mailing address:
  • Phone: 310-639-1907
  • Fax: 310-999-6568

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MR. MATTHEW ADELEKE
Title or Position: OWNER
Credential:
Phone: 310-639-1907