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General NPI Number Information
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NPI Number | 1700119567
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Entity Type | Individual
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Provider Name | BABAJIDE ADETOKUNBO FAJEMISIN PA-C
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Gender | Male
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Dates
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Enumeration Date | 09/11/2009
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Last Update Date | 11/27/2023
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Provider Practice Location Address
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Address Line | 15791 BEAR VALLEY RD
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City | HESPERIA
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State | CA
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Zip | 92345-1746
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Country | US
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Telephone | 760-949-1231
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Fax | 877-738-3841
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Provider Business Mailing Address
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Address Line | 625 FAIR OAKS AVE STE 270
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City | SOUTH PASADENA
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State | CA
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Zip | 91030-5801
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Country | US
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Telephone | 626-346-2455
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Fax | 626-639-3005
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA20295
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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