Individual
EBUNOLUWA OMOTOLA JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
14445 OLIVE VIEW DRIVE, SYLMAR, CA 91342
(818) 364-3107
Mailing address
11677 GOSHEN AVE, #312, LOS ANGELES, CA 90049-6291
(415) 577-8737
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
A112523
CA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
A112523
MEDICAL LICENSE
CA
Enumeration date
07/03/2008
Last updated
07/30/2012
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