Provider Demographics
NPI:1134811854
Name:OLOWU, DORCAS OLUWAPONMILE
Entity type:Individual
Prefix:
First Name:DORCAS
Middle Name:OLUWAPONMILE
Last Name:OLOWU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DORCAS
Other - Middle Name:O
Other - Last Name:FUNSOADEBAYO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1315 N BULLIS RD STE 6
Mailing Address - Street 2:
Mailing Address - City:COMPTON
Mailing Address - State:CA
Mailing Address - Zip Code:90221-1662
Mailing Address - Country:US
Mailing Address - Phone:562-506-7553
Mailing Address - Fax:
Practice Address - Street 1:1315 N BULLIS RD STE 6
Practice Address - Street 2:
Practice Address - City:COMPTON
Practice Address - State:CA
Practice Address - Zip Code:90221-1662
Practice Address - Country:US
Practice Address - Phone:562-506-7553
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-22
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst