Healthcare Provider Details

I. General information

NPI: 1144313800
Provider Name (Legal Business Name): OLUYEMISI S. AFUAPE, M.D., INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 ALESSANDRO PL. STE 100
PASADENA CA
91105
US

IV. Provider business mailing address

50 ALESSANDRO PL. STE 100
PASADENA CA
91105
US

V. Phone/Fax

Practice location:
  • Phone: 626-792-0717
  • Fax: 626-792-3703
Mailing address:
  • Phone: 626-792-0717
  • Fax: 626-792-3703

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberC2481028
License Number StateCA

VIII. Authorized Official

Name: DR. OLUYEMISI S. AFUAPE
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 626-792-0717