Healthcare Provider Details

I. General information

NPI: 1164341616
Provider Name (Legal Business Name): ADETOKUNBOH ADEGBITE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2026
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5601 W SLAUSON AVE STE 130
CULVER CITY CA
90230-6576
US

IV. Provider business mailing address

14432 KABANA LN APT 4
GARDENA CA
90247-5976
US

V. Phone/Fax

Practice location:
  • Phone: 310-910-0406
  • Fax:
Mailing address:
  • Phone: 310-910-0406
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: