Healthcare Provider Details

I. General information

NPI: 1922001429
Provider Name (Legal Business Name): ADEKUNLE NURUDEEN SHITTU M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/27/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 7TH ST
WASCO CA
93280-1502
US

IV. Provider business mailing address

8101 CAMINO MEDIA APT 100
BAKERSFIELD CA
93311-2026
US

V. Phone/Fax

Practice location:
  • Phone: 661-758-2263
  • Fax:
Mailing address:
  • Phone: 661-665-8147
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA81621
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: