Provider Demographics
NPI:1356368799
Name:OKETOLA, ELIZABETH IBITORU (DME PROVIDER)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:IBITORU
Last Name:OKETOLA
Suffix:
Gender:F
Credentials:DME PROVIDER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 766
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91729
Mailing Address - Country:US
Mailing Address - Phone:909-350-9700
Mailing Address - Fax:909-350-7340
Practice Address - Street 1:16756 FOOTHILL BLVD
Practice Address - Street 2:
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92335
Practice Address - Country:US
Practice Address - Phone:909-350-9700
Practice Address - Fax:909-350-7340
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies