Provider Demographics
NPI:1487421731
Name:ONWAEZE, ADETOUN ADEJOKE
Entity type:Individual
Prefix:
First Name:ADETOUN
Middle Name:ADEJOKE
Last Name:ONWAEZE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1742 W 59TH PL
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90047-1103
Mailing Address - Country:US
Mailing Address - Phone:323-327-3080
Mailing Address - Fax:
Practice Address - Street 1:1742 W 59TH PL
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90047-1103
Practice Address - Country:US
Practice Address - Phone:323-327-3080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-07
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities