Healthcare Provider Details

I. General information

NPI: 1790852945
Provider Name (Legal Business Name): ABIODUN OLUFEMI OBADINA M.D.,
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2006
Last Update Date: 07/12/2021
Certification Date: 07/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10333 EL CAMINO REAL
ATASCADERO CA
93422-5808
US

IV. Provider business mailing address

10333 EL CAMINO REAL
ATASCADERO CA
93422-5808
US

V. Phone/Fax

Practice location:
  • Phone: 805-468-2000
  • Fax:
Mailing address:
  • Phone: 805-468-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number45677
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number032268
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number45677
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: