MEDICARE: FUNMILOLA TOPE-ANIFOWOSE

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	43457	CA

General Provider Information

NPI Number	:	1982710430
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FUNMILOLA TOPE-ANIFOWOSE

Provider Business Mailing Address
First Line	:	10030 S WESTERN AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90047-4254
Country	:	US
Telephone Number	:	323-755-5550
Fax Number	:	323-755-5540

Provider Business Practice Location Address
First Line	:	10030 S WESTERN AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90047-4254
Country	:	US
Telephone Number	:	323-755-5550
Fax Number	:	323-755-5540

Authorized Official
Title or Position	:	OWNER
Name	:	FUNMILOLA TOPE-ANIFOWOSE
Credential	:
Telephone Number	:	323-755-5550

Provider Enumeration Date	:	08/21/2006
Last Update Date	:	08/26/2008

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