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General NPI Number Information
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NPI Number | 1003235243
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Entity Type | Individual
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Provider Name | OLUWASEYI SEGUN BALASIRE M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/15/2014
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 20103 LAKE CHABOT RD
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City | CASTRO VALLEY
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State | CA
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Zip | 94546-5305
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Country | US
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Telephone | 510-727-3256
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Fax | 510-727-3107
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Provider Business Mailing Address
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Address Line | 400 CHANEY RD APT 307
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City | SMYRNA
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State | TN
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Zip | 37167-2650
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Country | US
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Telephone | 813-389-8614
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Fax |
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 1118626
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 56261
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License Number State | TN
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Taxonomy #3
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | A152926
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License Number State | CA
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