Provider Demographics
NPI:1629714373
Name:OMOLAFE, LINDA OLUBUKOLA
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:OLUBUKOLA
Last Name:OMOLAFE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6661 INDIANA AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90805-2826
Mailing Address - Country:US
Mailing Address - Phone:562-353-0861
Mailing Address - Fax:
Practice Address - Street 1:5310 FOUNTAIN AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90029-1005
Practice Address - Country:US
Practice Address - Phone:323-461-9961
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-06
Last Update Date:2022-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33083235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist