MEDICARE: MODESOLA AKINBI

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies	45311	CA

General Provider Information

NPI Number	:	1619997061
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MODESOLA AKINBI

Provider Business Mailing Address
First Line	:	13414 1/ 2 SO. AVALON BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90061-2231
Country	:	US
Telephone Number	:	310-532-3080
Fax Number	:	310-532-3080

Provider Business Practice Location Address
First Line	:	13414 1/ 2 SO. AVALON BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90061-2231
Country	:	US
Telephone Number	:	310-532-3080
Fax Number	:	310-532-3080

Authorized Official
Title or Position	:	OWNER
Name	:	MODESOLA BIMBO AKINBI
Credential	:
Telephone Number	:	310-532-3080

Provider Enumeration Date	:	07/20/2006
Last Update Date	:	05/07/2011

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