Healthcare Provider Details

I. General information

NPI: 1174523518
Provider Name (Legal Business Name): YOMI A ADEYEMI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: YOMI A ADEYEMI M.D.

II. Dates (important events)

Enumeration Date: 07/28/2005
Last Update Date: 12/21/2025
Certification Date: 12/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

54910 APOLLO CT
LA QUINTA CA
92253-8051
US

IV. Provider business mailing address

54910 APOLLO CT
LA QUINTA CA
92253-8051
US

V. Phone/Fax

Practice location:
  • Phone: 708-261-8614
  • Fax:
Mailing address:
  • Phone: 708-261-8614
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PH0002X
TaxonomyHospice and Palliative Medicine (Emergency Medicine) Physician
License NumberC176511
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: