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General NPI Number Information
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NPI Number | 1841301884
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Entity Type | Individual
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Provider Name | BANKOLE SIMBO ASEBIOMO MD
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Gender | Male
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 04/28/2023
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Provider Practice Location Address
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Address Line | 3801 MIRANDA AVE
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City | PALO ALTO
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State | CA
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Zip | 94304-1207
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Country | US
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Telephone | 229-391-4100
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Fax |
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Provider Business Mailing Address
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Address Line | 3041 SKY WATCH WAY
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City | ROSEVILLE
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State | CA
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Zip | 95747-9378
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Country | US
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Telephone | 916-477-4944
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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 | 045706
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 207RI0200X
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Taxonomy Name | Infectious Disease Physician
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License Number | 045706
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License Number State | GA
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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 | 0101242047
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License Number State | VA
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Taxonomy #4
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | C163303
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License Number State | CA
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