Individual
MARY OLUBUKOLA FAKUNLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1260 15TH ST STE 1200, SANTA MONICA, CA 90404-1147
(310) 794-7700
Mailing address
5767 W CENTURY BLVD STE 400, LOS ANGELES, CA 90045-5631
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
A163588
CA
Other
Enumeration date
04/02/2018
Last updated
07/02/2024
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