Healthcare Provider Details

I. General information

NPI: 1306053590
Provider Name (Legal Business Name): IRENE ITOHAN OLADOKUN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11234 ANDERSON ST LLUMC, HOUSE STAFF OFFICE, COLEMAN PAVILLION 21005,
LOMA LINDA CA
92354-2804
US

IV. Provider business mailing address

11234 ANDERSON ST LLUMC, HOUSE STAFF OFFICE, COLEMAN PAVILLION 21005,
LOMA LINDA CA
92354-2804
US

V. Phone/Fax

Practice location:
  • Phone: 909-558-8131
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD227530
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA101618
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: