Provider Demographics
NPI:1255354148
Name:EZEAKU-OLIE, FLORENCE
Entity type:Individual
Prefix:MRS
First Name:FLORENCE
Middle Name:
Last Name:EZEAKU-OLIE
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 1:24017 NARBONNE AVE STE J
Mailing Address - Street 2:
Mailing Address - City:LOMITA
Mailing Address - State:CA
Mailing Address - Zip Code:90717-1166
Mailing Address - Country:US
Mailing Address - Phone:310-257-9084
Mailing Address - Fax:310-257-8976
Practice Address - Street 1:24017 NARBONNE AVE STE J
Practice Address - Street 2:
Practice Address - City:LOMITA
Practice Address - State:CA
Practice Address - Zip Code:90717-1166
Practice Address - Country:US
Practice Address - Phone:310-257-9084
Practice Address - Fax:310-257-8976
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2008-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5371150001Medicare NSC