Provider Demographics
NPI:1063672053
Name:ANTHONIO, TITILAYO ADEBOLA (LVN)
Entity type:Individual
Prefix:MRS
First Name:TITILAYO
Middle Name:ADEBOLA
Last Name:ANTHONIO
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22337 WELBY WAY
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91303-2466
Mailing Address - Country:US
Mailing Address - Phone:909-327-7102
Mailing Address - Fax:818-888-1962
Practice Address - Street 1:22337 WELBY WAY
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91303-2466
Practice Address - Country:US
Practice Address - Phone:909-327-7102
Practice Address - Fax:818-888-1962
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-12
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA214392164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse