Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225400000X | Rehabilitation Practitioner |
NPI | 1053666289 |
---|---|
Provider Name | Matthew Olufemi Egbedi |
First Address | Lynwood, CA 90262-4024 |
Second Address | Lynwood, CA 90262-4024 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/07/2012 |
Last Update Date | 19/11/2020 |