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General NPI Number Information
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NPI Number | 1619183811
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Entity Type | Organization
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Legal Business Name | ABAYOMI A. ODUBELA, M.D., A PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 05/15/2007
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Last Update Date | 06/21/2018
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Provider Practice Location Address
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Address Line | 25470 MEDICAL CENTER DR STE 205
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City | MURRIETA
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State | CA
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Zip | 92562-4901
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Country | US
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Telephone | 951-676-4221
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Fax | 951-676-0032
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Provider Business Mailing Address
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Address Line | PO BOX 972
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City | SUN CITY
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State | CA
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Zip | 92586-0972
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Country | US
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Telephone | 951-676-4221
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Fax | 951-676-0032
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Authorized Official
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Title or Position | CEO
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Name | DR. ABAYOMI ADESINA ODUBELA
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Credential | M.D.
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Telephone | 951-676-4221
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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 | A51039
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License Number State | CA
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