Healthcare Provider Details

I. General information

NPI: 1184394793
Provider Name (Legal Business Name): FRANCIS OLAOLUWA OGUNLEYE PA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2021
Last Update Date: 09/15/2021
Certification Date: 08/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1731 E 120TH ST
LOS ANGELES CA
90059
US

IV. Provider business mailing address

12700 INGLEWOOD AVE UNIT 699
HAWTHORNE CA
90251-2446
US

V. Phone/Fax

Practice location:
  • Phone: 424-552-6876
  • Fax:
Mailing address:
  • Phone: 424-552-6876
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: