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General NPI Number Information
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NPI Number | 1376089326
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Entity Type | Individual
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Provider Name | HAMEED ADEBOLA ADEWOLE
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Gender | Male
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Dates
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Enumeration Date | 01/15/2017
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Last Update Date | 01/15/2017
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Provider Practice Location Address
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Address Line | 17650 DEVONSHIRE ST
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City | NORTHRIDGE
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State | CA
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Zip | 91325-1445
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Country | US
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Telephone | 818-446-9879
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Fax |
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Provider Business Mailing Address
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Address Line | 4107 S HOBART BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90062-1621
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Country | US
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Telephone | 404-428-8296
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 292528
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License Number State | CA
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