Provider Demographics
NPI:1427085158
Name:ADENUGA, ESTHER ABIODUN
Entity type:Individual
Prefix:
First Name:ESTHER
Middle Name:ABIODUN
Last Name:ADENUGA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7850 S NORMANDIE AVE
Mailing Address - Street 2:APT. 68
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90044-2373
Mailing Address - Country:US
Mailing Address - Phone:323-992-5541
Mailing Address - Fax:
Practice Address - Street 1:7850 S NORMANDIE AVE
Practice Address - Street 2:APT. 68
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90044-2373
Practice Address - Country:US
Practice Address - Phone:323-992-5541
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00449063390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5072410001Medicare NSC