MEDICARE: IYABO O DARAMOLA MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	A463633	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1851378236
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IYABO O DARAMOLA MD

Provider Business Mailing Address
First Line	:	PO BOX 675833
Second Line	:
City	:	RANCHO SANTA FE
State	:	CA
Zip	:	92067-5833
Country	:	US
Telephone Number	:	619-489-6767
Fax Number	:	619-434-8840

Provider Business Practice Location Address
First Line	:	2401 REO DR
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92139
Country	:	US
Telephone Number	:	619-479-6767
Fax Number	:	619-434-3380

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/28/2005
Last Update Date	:	09/06/2013

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