Healthcare Provider Details

I. General information

NPI: 1376121418
Provider Name (Legal Business Name): PATRICK OLUMUYIWA SODEKE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2021
Last Update Date: 07/11/2024
Certification Date: 07/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4785 N FIRST ST KAISER PERMANENTE FIRST STREET MEDICAL OFFICE
FRESNO CA
93726
US

IV. Provider business mailing address

11039 N VIA ARGENTA WAY
FRESNO CA
93730-7067
US

V. Phone/Fax

Practice location:
  • Phone: 559-448-4555
  • Fax:
Mailing address:
  • Phone: 423-557-9623
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA193561
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: