Healthcare Provider Details

I. General information

NPI: 1619082773
Provider Name (Legal Business Name): OLUSOLA O OYEKALE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 06/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8760 S BROADWAY
LOS ANGELES CA
90003-3340
US

IV. Provider business mailing address

8760 S BROADWAY
LOS ANGELES CA
90003-3340
US

V. Phone/Fax

Practice location:
  • Phone: 323-971-3868
  • Fax: 323-971-3985
Mailing address:
  • Phone: 323-971-3868
  • Fax: 323-971-3985

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number5682730001
License Number StateCA

VIII. Authorized Official

Name: MRS. OLUSOLA OYEKALE
Title or Position: OWNER
Credential:
Phone: 323-971-3868