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General NPI Number Information
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NPI Number | 1013171479
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Entity Type | Organization
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Legal Business Name | SMARTWAY,INC
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Dates
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Enumeration Date | 07/15/2008
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Last Update Date | 07/15/2008
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Provider Practice Location Address
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Address Line | 460 E CARSON PLAZA DR STE 118
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City | CARSON
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State | CA
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Zip | 90746-3285
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Country | US
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Telephone | 310-809-9946
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Fax |
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Provider Business Mailing Address
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Address Line | 460 E CARSON PLAZA DR STE 118
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City | CARSON
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State | CA
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Zip | 90746-3285
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Country | US
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Telephone | 310-809-9946
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. EZEKIEL OYEGOKE
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Credential |
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Telephone | 310-562-0605
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251V00000X
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Taxonomy Name | Voluntary or Charitable Agency
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License Number | 2829468
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License Number State | CA
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