Provider Demographics
NPI:1699702191
Name:OYEBOBOLA, OLAWANDE
Entity type:Individual
Prefix:
First Name:OLAWANDE
Middle Name:
Last Name:OYEBOBOLA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7255 WOODLEY AVE
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91406-3421
Mailing Address - Country:US
Mailing Address - Phone:818-989-4030
Mailing Address - Fax:818-989-4126
Practice Address - Street 1:7255 WOODLEY AVE
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91406-3421
Practice Address - Country:US
Practice Address - Phone:818-989-4030
Practice Address - Fax:818-989-4126
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103022225CA2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225CA2500XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation CounselorAssistive Technology Supplier