Healthcare Provider Details

I. General information

NPI: 1568551752
Provider Name (Legal Business Name): N OLATUNJI OLAMBIWONNU M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 N MADISON AVE SUITE 304
PASADENA CA
91101-2035
US

IV. Provider business mailing address

65 N MADISON AVE SUITE 304
PASADENA CA
91101-2035
US

V. Phone/Fax

Practice location:
  • Phone: 626-795-5125
  • Fax: 626-795-7969
Mailing address:
  • Phone: 626-795-5125
  • Fax: 626-795-7969

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License NumberG18111
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License NumberG18111
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: