Healthcare Provider Details

I. General information

NPI: 1700950151
Provider Name (Legal Business Name): OLUWAFEMI ADEYEMO,M.D PROFESSIONAL MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/19/2006
Last Update Date: 01/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

540 N SAN JACINTO ST SUITE C
HEMET CA
92543-3154
US

IV. Provider business mailing address

PO BOX 358
SAN JACINTO CA
92581-0358
US

V. Phone/Fax

Practice location:
  • Phone: 951-492-0728
  • Fax: 951-332-8245
Mailing address:
  • Phone: 951-492-0728
  • Fax: 951-332-8245

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License NumberA86706
License Number StateCA

VIII. Authorized Official

Name: DR. OLUWAFEMI A ADEYEMO
Title or Position: PRESIDENT
Credential: M.D.
Phone: 951-492-0728