Provider Demographics
NPI:1205857125
Name:AWUJO, SILAS OBUMNEKE
Entity Type:Individual
Prefix:MR
First Name:SILAS
Middle Name:OBUMNEKE
Last Name:AWUJO
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 1:541 W MANCHESTER BLVD
Mailing Address - Street 2:STE 104
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90301
Mailing Address - Country:US
Mailing Address - Phone:310-330-3933
Mailing Address - Fax:310-330-3951
Practice Address - Street 1:541 W MANCHESTER BLVD
Practice Address - Street 2:STE 104
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90301
Practice Address - Country:US
Practice Address - Phone:310-330-3933
Practice Address - Fax:310-330-3951
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-23
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA102746332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
4853820001Medicare NSC