Provider Demographics
NPI:1922847474
Name:OLAGUNJU, OMOTUNDE TITILOPE (MD)
Entity type:Individual
Prefix:MISS
First Name:OMOTUNDE
Middle Name:TITILOPE
Last Name:OLAGUNJU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 EAST HARDY STREET
Mailing Address - Street 2:
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90301
Mailing Address - Country:US
Mailing Address - Phone:310-680-8374
Mailing Address - Fax:310-412-4021
Practice Address - Street 1:555 EAST HARDY STREET
Practice Address - Street 2:
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90301
Practice Address - Country:US
Practice Address - Phone:310-680-8374
Practice Address - Fax:310-412-4021
Is Sole Proprietor?:No
Enumeration Date:2024-05-23
Last Update Date:2024-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program