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General NPI Number Information
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NPI Number | 1003174384
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Entity Type | Individual
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Provider Name | OLUYOMI OBAFEMI M.D.
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Gender | Female
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Dates
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Enumeration Date | 04/24/2012
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Last Update Date | 05/13/2025
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Provider Practice Location Address
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Address Line | 649 HARKLE RD STE E
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City | SANTA FE
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State | NM
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Zip | 87505-4765
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Country | US
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Telephone | 505-955-9454
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 6880
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City | SANTA FE
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State | NM
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Zip | 87502-6880
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Country | US
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Telephone | 505-216-0332
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Fax | 505-982-0279
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2083P0901X
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Taxonomy Name | Public Health & General Preventive Medicine Physician
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License Number | DR.0056983
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | MT202124
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License Number State | PA
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Taxonomy #3
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | MD452377
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License Number State | PA
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Taxonomy #4
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Taxonomy Code | 2083P0901X
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Taxonomy Name | Public Health & General Preventive Medicine Physician
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License Number | MD2025-0100
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License Number State | NM
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