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General NPI Number Information
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NPI Number | 1548414972
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Entity Type | Individual
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Provider Name | OLORUNTOYIN K. LIADI
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Gender | Female
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Dates
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Enumeration Date | 11/12/2008
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Last Update Date | 05/18/2010
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Provider Practice Location Address
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Address Line | 326 ORANGE SHOW LN
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City | SAN BERNARDINO
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State | CA
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Zip | 92408-2023
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Country | US
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Telephone | 909-888-1674
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Fax | 909-888-1677
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Provider Business Mailing Address
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Address Line | 326 ORANGE SHOW LN
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City | SAN BERNARDINO
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State | CA
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Zip | 92408-2023
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Country | US
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Telephone | 909-888-1674
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Fax | 909-888-1677
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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 | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 50333
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License Number State | CA
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