Provider Demographics
NPI:1942327382
Name:ADOMOU, DESIRE ORENS
Entity Type:Individual
Prefix:MR
First Name:DESIRE
Middle Name:ORENS
Last Name:ADOMOU
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 1:5850 BENNER ST APT 305
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90042-4730
Mailing Address - Country:US
Mailing Address - Phone:323-256-4687
Mailing Address - Fax:323-256-4687
Practice Address - Street 1:1200 WILSHIRE BLVD STE 500
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90017-1934
Practice Address - Country:US
Practice Address - Phone:213-481-4260
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator