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General NPI Number Information
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NPI Number | 1104047950
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Entity Type | Organization
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Legal Business Name | SANTOS OLUMESE
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Dates
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Enumeration Date | 05/01/2007
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Last Update Date | 12/26/2008
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Provider Practice Location Address
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Address Line | 4969 W ADAMS BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90016-2849
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Country | US
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Telephone | 323-373-1870
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Fax | 323-212-3511
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Provider Business Mailing Address
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Address Line | 4969 W ADAMS BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90016-2849
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Country | US
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Telephone | 323-373-1870
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Fax | 323-212-3511
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Authorized Official
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Title or Position | DIRECTOR OF OPERATIONS
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Name | MR. SANTOS OLUMESE
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Credential |
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Telephone | 323-373-1870
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | HMDRL 47070
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License Number State | CA
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