Healthcare Provider Details

I. General information

NPI: 1447014576
Provider Name (Legal Business Name): OLUSOLA D FALODE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/08/2024
Last Update Date: 02/08/2024
Certification Date: 02/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 OCEAN VIEW AVE APT 22
LOS ANGELES CA
90057-2293
US

IV. Provider business mailing address

2401 OCEAN VIEW AVE APT 22
LOS ANGELES CA
90057-2293
US

V. Phone/Fax

Practice location:
  • Phone: 323-472-0915
  • Fax:
Mailing address:
  • Phone: 323-472-0915
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number00444012
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: