Provider Demographics
NPI:1366951113
Name:OGUNDIPE, KOLA (RN)
Entity type:Individual
Prefix:MR
First Name:KOLA
Middle Name:
Last Name:OGUNDIPE
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1731 STEARNS DR
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90035-4627
Mailing Address - Country:US
Mailing Address - Phone:310-404-4829
Mailing Address - Fax:323-375-1771
Practice Address - Street 1:1731 STEARNS DR
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90035-4627
Practice Address - Country:US
Practice Address - Phone:310-404-4829
Practice Address - Fax:323-375-1771
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA542332163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine