Provider Demographics
NPI:1003686734
Name:SUBAIR, OLAITAN ADEPEJU
Entity Type:Individual
Prefix:
First Name:OLAITAN
Middle Name:ADEPEJU
Last Name:SUBAIR
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 1:19609 SHERMAN WAY APT 201
Mailing Address - Street 2:
Mailing Address - City:RESEDA
Mailing Address - State:CA
Mailing Address - Zip Code:91335-3430
Mailing Address - Country:US
Mailing Address - Phone:747-253-8024
Mailing Address - Fax:
Practice Address - Street 1:19609 SHERMAN WAY APT 201
Practice Address - Street 2:
Practice Address - City:RESEDA
Practice Address - State:CA
Practice Address - Zip Code:91335-3430
Practice Address - Country:US
Practice Address - Phone:747-253-8024
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-04
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA732207164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse