Provider Demographics
NPI:1568476943
Name:CAREW-AKENZUA, OYINDAMOLA F (MD)
Entity type:Individual
Prefix:
First Name:OYINDAMOLA
Middle Name:F
Last Name:CAREW-AKENZUA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:OYINDA
Other - Middle Name:F
Other - Last Name:AKENZUA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:8540 S SEPULVEDA BLVD
Mailing Address - Street 2:#916
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-3807
Mailing Address - Country:US
Mailing Address - Phone:310-417-4014
Mailing Address - Fax:310-417-8470
Practice Address - Street 1:8540 S SEPULVEDA BLVD
Practice Address - Street 2:#916
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90045-3807
Practice Address - Country:US
Practice Address - Phone:310-417-4014
Practice Address - Fax:310-417-8470
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2010-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA62206207Q00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A62206Medicaid
CA00A622060OtherBLUE SHIELD OF CALIFORNIA
CA00A62206Medicaid
CA00A62206Medicaid
CA00A622060OtherBLUE SHIELD OF CALIFORNIA