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General NPI Number Information
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NPI Number | 1891159083
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Entity Type | Individual
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Provider Name | OLUKEMI ODUYERU
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Gender | Female
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Dates
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Enumeration Date | 04/13/2016
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Last Update Date | 12/30/2024
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Provider Practice Location Address
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Address Line | 22 AREA MARINE CENTERED MEDICAL HOME CAMP
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City | PENDLETON
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State | CA
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Zip | 92058
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Country | US
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Telephone | 760-725-3784
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 555911
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City | CAMP PENDLETON
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State | CA
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Zip | 92055-5911
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Country | US
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Telephone |
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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 | 171000000X
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Taxonomy Name | Military Health Care Provider
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License Number | DR.0067018
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | DR.0067018
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License Number State | CO
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