Healthcare Provider Details

I. General information

NPI: 1649895301
Provider Name (Legal Business Name): ADELAIDE OBIANUJU UBAH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2020
Last Update Date: 03/21/2024
Certification Date: 03/21/2024
Deactivation Date: 01/18/2022
Reactivation Date: 02/22/2022

III. Provider practice location address

121 BARBOZA ST
MENDOTA CA
93640-1901
US

IV. Provider business mailing address

3875 W BEECHWOOD AVE
FRESNO CA
93711-0795
US

V. Phone/Fax

Practice location:
  • Phone: 516-572-5049
  • Fax:
Mailing address:
  • Phone: 8-492-4227
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA192395
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: