Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2084N0400X | Neurologist | A115049 | CA |
N | 2084N0400X | Neurologist | ME123858 | FL |
NPI | 1043442197 |
---|---|
Provider Name | Maranatha Ayodele |
First Address | Los Angeles, CA 90051-0717 |
Second Address | West Hollywood, CA 90048-1804 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/08/2009 |
Last Update Date | 02/12/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1043442197 | (05) | CA |