Healthcare Provider Details

I. General information

NPI: 1700730801
Provider Name (Legal Business Name): JUBRIL A LAWAL DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/25/2026
Last Update Date: 02/25/2026
Certification Date: 02/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34800 BOB WILSON DRIVE SAN DIEGO CA 92134
SAN DIEGO CA
92134-0001
US

IV. Provider business mailing address

4041 CHOUTEAU AVE APT 427
SAINT LOUIS MO
63110-1751
US

V. Phone/Fax

Practice location:
  • Phone: 619-532-6400
  • Fax:
Mailing address:
  • Phone: 347-254-2294
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: