Individual ProviderJonathan OlumoyaFamily MedicineAllopathic & Osteopathic PhysiciansPractice Address2801 S San Pedro St, Los Angeles, CA 90011-2023(323) 233-3100PECOS EnrollmentBased on the most recent information from CMS, provider Jonathan Olumoya is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.Part BMedicare Part BEnrolledHHAHome Health AgencyEnrolledDMEDurable Medical EquipmentEnrolledPMDPower Mobility DeviceEnrolledCMS last updated its PECOS records 15 days ago.Profile DetailsProvider ID1053668434Provider TypeIndividualFull NameOlumoya, JonathanTitleDr.CredentialM.D.GenderMaleSole ProprietorYesEnumeration Date8/5/2012Last Updated7/14/2021Contact InformationPractice LocationPractice Address2801 S San Pedro St, Los Angeles, CA 90011-2023Phone(323) 233-3100Fax(323) 233-4100Mailing LocationMailing Address2801 S San Pedro St, Los Angeles, CA 90011-2023Phone(323) 233-3100Fax(323) 233-4100Provider TaxonomiesCodeDescriptionLicenseCode207Q00000XPrimaryDescriptionFamily MedicineAllopathic & Osteopathic PhysiciansLicenseA131566California