Healthcare Provider Details

I. General information

NPI: 1376552141
Provider Name (Legal Business Name): BOLANLE ABIMBOLA OLAJIDE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/07/2006
Last Update Date: 02/06/2026
Certification Date: 02/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

433 N 4TH ST STE 205A
MONTEBELLO CA
90640-4311
US

IV. Provider business mailing address

433 N 4TH ST STE 205A
MONTEBELLO CA
90640-4311
US

V. Phone/Fax

Practice location:
  • Phone: 323-920-0505
  • Fax:
Mailing address:
  • Phone: 323-920-0505
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA69322
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: