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General NPI Number Information
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NPI Number | 1831596865
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Entity Type | Organization
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Legal Business Name | IYABO DARAMOLA MD INC
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Dates
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Enumeration Date | 11/19/2014
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Last Update Date | 11/19/2014
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Provider Practice Location Address
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Address Line | 1685 E MAIN ST SUITE 102
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City | EL CAJON
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State | CA
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Zip | 92021-5225
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Country | US
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Telephone | 619-479-6767
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Fax | 619-434-8840
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Provider Business Mailing Address
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Address Line | PO BOX 675833
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City | RANCHO SANTA FE
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State | CA
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Zip | 92067-5833
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Country | US
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Telephone | 619-479-6767
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Fax | 619-434-8840
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. IYABO O DARAMOLA
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Credential | M.D.
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Telephone | 619-479-6767
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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 | A63633
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License Number State | CA
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