Provider Demographics
NPI:1952764680
Name:FOYABO, JUDITH MBEWO
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:MBEWO
Last Name:FOYABO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JUDITH
Other - Middle Name:MBEWO
Other - Last Name:CASPA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:311 WINSTON ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90013-1519
Mailing Address - Country:US
Mailing Address - Phone:213-893-1960
Mailing Address - Fax:
Practice Address - Street 1:311 WINSTON ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90013-1519
Practice Address - Country:US
Practice Address - Phone:213-893-1960
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-31
Last Update Date:2016-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95004049363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA95004049OtherBOARD OF REGISTERED NURSING