Healthcare Provider Details

I. General information

NPI: 1942496096
Provider Name (Legal Business Name): OLUYEMISI ADERONKE OLUBI MD, MPH.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: OLUYEMISI ADERONKE AKINHANMI MD.

II. Dates (important events)

Enumeration Date: 09/22/2007
Last Update Date: 06/16/2024
Certification Date: 06/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

760 S WASHBURN AVE STE 22
CORONA CA
92882
US

IV. Provider business mailing address

11762 DE PALMA RD STE 1C #507
CORONA CA
92883-8494
US

V. Phone/Fax

Practice location:
  • Phone: 951-638-1315
  • Fax:
Mailing address:
  • Phone: 612-306-7858
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083P0500X
TaxonomyPreventive Medicine/Occupational Environmental Medicine Physician
License Number41044
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code2083P0500X
TaxonomyPreventive Medicine/Occupational Environmental Medicine Physician
License Number19788
License Number StateMN
# 3
Primary TaxonomyN
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number41044
License Number StateAZ
# 4
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number41044
License Number StateAZ
# 5
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License NumberC144689
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: