Provider Demographics
NPI:1275371031
Name:FALODUN, FUNKE (RDMS)
Entity type:Individual
Prefix:
First Name:FUNKE
Middle Name:
Last Name:FALODUN
Suffix:
Gender:F
Credentials:RDMS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18714 BIG CEDAR DR
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARITA
Mailing Address - State:CA
Mailing Address - Zip Code:91387-1451
Mailing Address - Country:US
Mailing Address - Phone:661-373-3498
Mailing Address - Fax:
Practice Address - Street 1:27141 HIDAWAY AVE STE 200
Practice Address - Street 2:
Practice Address - City:SANTA CLARITA
Practice Address - State:CA
Practice Address - Zip Code:91351-4144
Practice Address - Country:US
Practice Address - Phone:661-373-3498
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-17
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA172267246XS1301X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246XS1301XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist CardiovascularSonography