Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VM0101X | Gynecologist - Maternal & Fetal Medicine | G64561 | CA |
NPI | 1316027360 |
---|---|
Provider Name | Anthony Ogundipe |
First Address | Lynwood, CA 90262-2646 |
Second Address | Lynwood, CA 90262-2646 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/10/2006 |
Last Update Date | 16/12/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G645612 | (05) | CA |
F11806 | (02) | CA |