Healthcare Provider Details

I. General information

NPI: 1720240864
Provider Name (Legal Business Name): ADEYINKA A OBAJIMI D.O
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2008
Last Update Date: 06/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19448 SW 27TH ST
MIRAMAR FL
33029-2484
US

IV. Provider business mailing address

19448 SW 27TH ST
MIRAMAR FL
33029-2484
US

V. Phone/Fax

Practice location:
  • Phone: 954-665-7905
  • Fax:
Mailing address:
  • Phone: 954-665-7905
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number920 0795
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: