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General NPI Number Information
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NPI Number | 1699852871
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Entity Type | Organization
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Legal Business Name | OLUSEGUN Z. SALAKO M.D. INC
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Dates
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Enumeration Date | 11/01/2006
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Last Update Date | 11/01/2012
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Provider Practice Location Address
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Address Line | 1951 PACIFIC AVE
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City | LONG BEACH
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State | CA
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Zip | 90806-5321
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Country | US
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Telephone | 562-218-6264
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Fax | 562-218-0745
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Provider Business Mailing Address
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Address Line | 1951 PACIFIC AVE
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City | LONG BEACH
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State | CA
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Zip | 90806-5321
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Country | US
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Telephone | 562-218-6264
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Fax | 562-218-0745
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Authorized Official
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Title or Position | PEDIATRIC SPECIALIST/MEDICAL DIRECT
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Name | DR. THECLA N. MGBOJIRKWE
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Credential | M.D.
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Telephone | 562-218-6264
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | A83572
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | G67118
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License Number State | CA
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