Provider Demographics
NPI:1508239286
Name:OJEDIRAN, OMOBOLA FELICIA (MSW, ACSW, AODCERT)
Entity Type:Individual
Prefix:
First Name:OMOBOLA
Middle Name:FELICIA
Last Name:OJEDIRAN
Suffix:
Gender:F
Credentials:MSW, ACSW, AODCERT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4388 KATELLA AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ALAMITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90720-3565
Mailing Address - Country:US
Mailing Address - Phone:562-596-0050
Mailing Address - Fax:
Practice Address - Street 1:4388 KATELLA AVE
Practice Address - Street 2:
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720-3565
Practice Address - Country:US
Practice Address - Phone:562-596-0050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-04
Last Update Date:2018-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW62200104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker