Healthcare Provider Details

I. General information

NPI: 1841796976
Provider Name (Legal Business Name): OLUWATOMISIN OBAFEMI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2018
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2888 LONG BEACH BLVD STE 165
LONG BEACH CA
90806-1561
US

IV. Provider business mailing address

2888 LONG BEACH BLVD STE 165
LONG BEACH CA
90806-1561
US

V. Phone/Fax

Practice location:
  • Phone: 657-241-9052
  • Fax: 714-665-4663
Mailing address:
  • Phone: 657-241-9052
  • Fax: 714-665-4663

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number101841
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: