Healthcare Provider Details

I. General information

NPI: 1548388531
Provider Name (Legal Business Name): TEMITAYO THAISE AKINSHILO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3520 HUGHES AVE 206
LOS ANGELES CA
90034-3970
US

IV. Provider business mailing address

3520 HUGHES AVE 206
LOS ANGELES CA
90034-3970
US

V. Phone/Fax

Practice location:
  • Phone: 310-837-8849
  • Fax:
Mailing address:
  • Phone: 310-837-8849
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225000000X
TaxonomyOrthotic Fitter
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: