Provider Demographics
NPI:1114025426
Name:AFOLABI, AKINOLA EMMANUEL
Entity Type:Individual
Prefix:MR
First Name:AKINOLA
Middle Name:EMMANUEL
Last Name:AFOLABI
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 1:1330 E SOUTH ST
Mailing Address - Street 2:UNIT 5
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90805
Mailing Address - Country:US
Mailing Address - Phone:562-422-3999
Mailing Address - Fax:562-422-3988
Practice Address - Street 1:1330 E SOUTH ST
Practice Address - Street 2:UNIT 5
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90805
Practice Address - Country:US
Practice Address - Phone:562-422-3999
Practice Address - Fax:562-422-3988
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA45002332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
5292700001Medicare NSC