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General NPI Number Information
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NPI Number | 1902887706
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Entity Type | Individual
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Provider Name | AYOTUNDE KOFOWOROLA AYODELE M.D.
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Gender | Male
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Dates
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Enumeration Date | 11/09/2005
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Last Update Date | 07/14/2025
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Provider Practice Location Address
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Address Line | 1920 MEMORIAL DR
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City | CERES
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State | CA
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Zip | 95307-1827
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Country | US
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Telephone | 209-383-7441
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Fax |
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Provider Business Mailing Address
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Address Line | 430 S HERLONG AVE SUITE 104
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City | ROCK HILL
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State | SC
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Zip | 29732-9446
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Country | US
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Telephone | 803-980-6610
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Fax | 803-980-6162
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 199147
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | SC 21581
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License Number State | SC
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Taxonomy #3
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 21581
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License Number State | SC
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