MEDICARE: MR. TOYIN DANIEL ALADESURU I

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	163W00000X	Registered Nurse	95082064	CA

General Provider Information

NPI Number	:	1780287946
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. TOYIN DANIEL ALADESURU I

Provider Business Mailing Address
First Line	:	1726 1/2 N MARIPOSA AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90027-3903
Country	:	US
Telephone Number	:	310-955-0023
Fax Number	:

Provider Business Practice Location Address
First Line	:	1726 1/2 N MARIPOSA AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90027-3903
Country	:	US
Telephone Number	:	310-955-0023
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/19/2020
Last Update Date	:	11/19/2020

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