Healthcare Provider Details

I. General information

NPI: 1811818552
Provider Name (Legal Business Name): IFITUMI AUDU
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2026
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5601 W SLAUSON AVE
CULVER CITY CA
90230-6582
US

IV. Provider business mailing address

945 E MEADBROOK ST
CARSON CA
90746-1631
US

V. Phone/Fax

Practice location:
  • Phone: 213-448-3060
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-26-530784
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: