Provider Demographics
NPI:1427286582
Name:ABE, BOLATITO M (MD)
Entity type:Individual
Prefix:DR
First Name:BOLATITO
Middle Name:M
Last Name:ABE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2022 DELAWARE AVE
Mailing Address - Street 2:#2
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404-4864
Mailing Address - Country:US
Mailing Address - Phone:310-876-9665
Mailing Address - Fax:310-310-3444
Practice Address - Street 1:4955 VAN NUYS BLVD
Practice Address - Street 2:502
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91403-1801
Practice Address - Country:US
Practice Address - Phone:818-325-0200
Practice Address - Fax:818-325-0210
Is Sole Proprietor?:No
Enumeration Date:2009-06-29
Last Update Date:2013-06-25
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Provider Licenses
StateLicense IDTaxonomies
GA003784207Q00000X
CAA122841208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist