Provider Demographics
NPI:1083862684
Name:ODUMOSU, ROTIMI A
Entity Type:Individual
Prefix:
First Name:ROTIMI
Middle Name:A
Last Name:ODUMOSU
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:PO BOX 341464
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90034-9464
Mailing Address - Country:US
Mailing Address - Phone:310-839-0474
Mailing Address - Fax:
Practice Address - Street 1:3756 CARDIFF AVE
Practice Address - Street 2:# 109
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90034-8816
Practice Address - Country:US
Practice Address - Phone:310-839-0474
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-08
Last Update Date:2008-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)