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General NPI Number Information
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NPI Number | 1336137678
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Entity Type | Organization
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Legal Business Name | MODUPEOLA ADEDEJI
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Dates
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Enumeration Date | 10/11/2005
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Last Update Date | 07/07/2008
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Provider Practice Location Address
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Address Line | 530 SAN PEDRO AVE
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City | SAN ANTONIO
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State | TX
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Zip | 78212-5006
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Country | US
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Telephone | 210-697-5700
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Fax | 210-558-9032
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Provider Business Mailing Address
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Address Line | 530 SAN PEDRO AVE
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City | SAN ANTONIO
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State | TX
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Zip | 78212-5006
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Country | US
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Telephone | 210-697-5700
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Fax | 210-558-9032
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Authorized Official
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Title or Position | CEO
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Name | MR. ADEDIRAN ADEDEJI
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Credential |
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Telephone | 210-697-5700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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