Healthcare Provider Details

I. General information

NPI: 1356523765
Provider Name (Legal Business Name): OLAYINKA FAJANA ALONGE MD LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2007
Last Update Date: 07/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5380 S RAINBOW BLVD #228
LAS VEGAS NV
89118-1877
US

IV. Provider business mailing address

5380 S RAINBOW BLVD #228
LAS VEGAS NV
89118-1877
US

V. Phone/Fax

Practice location:
  • Phone: 702-222-3478
  • Fax:
Mailing address:
  • Phone: 702-222-3478
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2000245650
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number29D1025313
License Number StateNV

VIII. Authorized Official

Name: DR. OLAYINKA F ALONGE
Title or Position: MEDICAL DOCTOR
Credential: MD
Phone: 702-222-3478