Provider Demographics
NPI:1245353622
Name:OYEWOLE, JOSEPHINE A
Entity type:Individual
Prefix:
First Name:JOSEPHINE
Middle Name:A
Last Name:OYEWOLE
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 1:225 S RIVERSIDE AVE
Mailing Address - Street 2:SUITE 4
Mailing Address - City:RIALTO
Mailing Address - State:CA
Mailing Address - Zip Code:92376-6458
Mailing Address - Country:US
Mailing Address - Phone:909-875-3398
Mailing Address - Fax:909-875-3499
Practice Address - Street 1:225 S RIVERSIDE AVE
Practice Address - Street 2:SUITE 4
Practice Address - City:RIALTO
Practice Address - State:CA
Practice Address - Zip Code:92376-6458
Practice Address - Country:US
Practice Address - Phone:909-875-3398
Practice Address - Fax:909-875-3499
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2008-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47030332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5944330001Medicare NSC