Provider Demographics
NPI:1073101556
Name:LIPEDE, MOBOLAJI (DPT)
Entity Type:Individual
Prefix:
First Name:MOBOLAJI
Middle Name:
Last Name:LIPEDE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:MOBOLAJI
Other - Middle Name:
Other - Last Name:SHOYINKA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:11556 BURBANK BLVD APT 303
Mailing Address - Street 2:
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91601-2351
Mailing Address - Country:US
Mailing Address - Phone:972-352-7626
Mailing Address - Fax:
Practice Address - Street 1:11556 BURBANK BLVD APT 303
Practice Address - Street 2:
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91601-2351
Practice Address - Country:US
Practice Address - Phone:972-352-7626
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-09
Last Update Date:2021-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT40115208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation