Provider Demographics
NPI:1487781043
Name:AKINLOYE, SONGOLAYE (PA)
Entity type:Individual
Prefix:
First Name:SONGOLAYE
Middle Name:
Last Name:AKINLOYE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:LAYE
Other - Middle Name:
Other - Last Name:AKINLOYE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA
Mailing Address - Street 1:PO BOX 512717
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90051-0717
Mailing Address - Country:US
Mailing Address - Phone:310-967-1884
Mailing Address - Fax:866-696-7655
Practice Address - Street 1:8700 BEVERLY BLVD.
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-1865
Practice Address - Country:US
Practice Address - Phone:310-967-1884
Practice Address - Fax:866-696-7655
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA 11689363A00000X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Not Answered363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAR36548Medicare UPIN