Healthcare Provider Details

I. General information

NPI: 1417118159
Provider Name (Legal Business Name): IBIRONKE VIVIAN ADELAJA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2008
Last Update Date: 11/27/2024
Certification Date: 11/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2335 E KASHIAN LN STE 220
FRESNO CA
93701-2211
US

IV. Provider business mailing address

2625 E DIVISADERO ST
FRESNO CA
93721-1431
US

V. Phone/Fax

Practice location:
  • Phone: 559-256-5140
  • Fax: 559-485-4505
Mailing address:
  • Phone: 559-443-2682
  • Fax: 559-443-2681

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberA102787
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: