Provider Demographics
NPI:1922017268
Name:BAMIRO, FOLAKE OLAWUNMI
Entity Type:Individual
Prefix:MRS
First Name:FOLAKE
Middle Name:OLAWUNMI
Last Name:BAMIRO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:FOLAKE
Other - Middle Name:
Other - Last Name:BAMIRO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LVN
Mailing Address - Street 1:5208 W PICO BLVD STE 3
Mailing Address - Street 2:SUITE#3
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90019-4054
Mailing Address - Country:US
Mailing Address - Phone:323-964-9908
Mailing Address - Fax:323-964-9915
Practice Address - Street 1:5208 W PICO BLVD STE 3
Practice Address - Street 2:SUITE#3
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90019-4054
Practice Address - Country:US
Practice Address - Phone:323-964-9908
Practice Address - Fax:323-964-9915
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA44854332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies