Provider Demographics
NPI:1992102420
Name:AKOLO, REBECCA M (DPM)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:M
Last Name:AKOLO
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25279 TAYLOR ST
Mailing Address - Street 2:UNIT A
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92354-3054
Mailing Address - Country:US
Mailing Address - Phone:510-289-6090
Mailing Address - Fax:
Practice Address - Street 1:25279 TAYLOR ST
Practice Address - Street 2:UNIT A
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92354-3054
Practice Address - Country:US
Practice Address - Phone:510-528-9609
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-26
Last Update Date:2014-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6707213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery