MEDICARE: MATERNAL-FETAL MEDICINE ASSOCIATES

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	207VM0101X	Maternal & Fetal Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1710029616
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MATERNAL-FETAL MEDICINE ASSOCIATES

Provider Business Mailing Address
First Line	:	401 MANCHESTER BLVD.
Second Line	:
City	:	INGLEWOOD
State	:	CA
Zip	:	90301-1109
Country	:	US
Telephone Number	:	310-672-2288
Fax Number	:	310-672-2266

Provider Business Practice Location Address
First Line	:	3628 E. IMPERIAL
Second Line	:	SUITE 200
City	:	LYNWOOD
State	:	CA
Zip	:	90262-2646
Country	:	US
Telephone Number	:	310-603-2345
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT/OWNER
Name	:	ANTHONY OGUNDIPE
Credential	:	MD
Telephone Number	:	310-603-2345

Provider Enumeration Date	:	02/14/2007
Last Update Date	:	06/03/2015

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