Healthcare Provider Details

I. General information

NPI: 1063695799
Provider Name (Legal Business Name): LAIDE ADELE AJIKE JINADU M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2007
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9300 VALLEY CHILDRENS PL # SE13
MADERA CA
93636-8761
US

IV. Provider business mailing address

9300 VALLEY CHILDREN'S PLACE SC05
MADERA CA
93636-8761
US

V. Phone/Fax

Practice location:
  • Phone: 559-353-5770
  • Fax: 559-353-5822
Mailing address:
  • Phone: 559-353-5700
  • Fax: 559-353-5708

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberD69359
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code2080P0210X
TaxonomyPediatric Nephrology Physician
License NumberA91917
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: