Individual
EDOBA ASEMOTA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2019 LOS FELIZ DR, THOUSAND OAKS, CA 91362-3070
(805) 341-1073
Mailing address
2019 LOS FELIZ DR, THOUSAND OAKS, CA 91362-3070
(805) 341-1073
Taxonomy
Speciality
Code
Description
License number
State
347C00000X
Private Vehicle
Primary
A6116572
CA
Other
Enumeration date
08/18/2020
Last updated
08/18/2020
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