Healthcare Provider Details

I. General information

NPI: 1326792128
Provider Name (Legal Business Name): OLUSEYI AWODELE M.D. A PROFESSIONAL MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2022
Last Update Date: 04/08/2025
Certification Date: 04/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3257 CAMINO DE LOS COCHES STE 305
CARLSBAD CA
92009-8974
US

IV. Provider business mailing address

3257 CAMINO DE LOS COCHES STE 305
CARLSBAD CA
92009-8974
US

V. Phone/Fax

Practice location:
  • Phone: 619-940-6269
  • Fax: 833-330-2683
Mailing address:
  • Phone: 760-452-6387
  • Fax: 833-330-2628

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QX0100X
TaxonomyOccupational Medicine Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: OLUSEYI AWODELE
Title or Position: PHYSICIAN
Credential: MD
Phone: 760-452-6387