Healthcare Provider Details

I. General information

NPI: 1528755741
Provider Name (Legal Business Name): DEBORAH DAMILOLA OMOLEYE M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DR. DEBORAH OLUWADAMILOLA FASOGBON

II. Dates (important events)

Enumeration Date: 04/18/2023
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3425 N 1ST ST
FRESNO CA
93726-6821
US

IV. Provider business mailing address

940 W GRIFFITH WAY
FRESNO CA
93705-2554
US

V. Phone/Fax

Practice location:
  • Phone: 877-960-3426
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA206299
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: