Provider Demographics
NPI:1801041223
Name:POPOOLA, RONKE T
Entity type:Individual
Prefix:MRS
First Name:RONKE
Middle Name:T
Last Name:POPOOLA
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 1:8353 5TH ST
Mailing Address - Street 2:103
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90241-3849
Mailing Address - Country:US
Mailing Address - Phone:310-462-7070
Mailing Address - Fax:
Practice Address - Street 1:8353 5TH ST
Practice Address - Street 2:103
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90241-3849
Practice Address - Country:US
Practice Address - Phone:310-462-7070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-26
Last Update Date:2008-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA635045164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse