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NPI Code Detail

MEDICARE: OLANIYI FADEYI MD

MEDICARE: OLANIYI FADEYI MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1390200000XStudent in an Organized Health Care Education/Training Program
2207R00000XInternal Medicine PhysicianA191379CA

General Provider Information

NPI Number : 1487275194
Entity Type Code : Individual
Provider Name (Legal Business Name) : OLANIYI FADEYI MD
Provider Business Mailing Address
First Line : 3102 HAINE DR APT 212
Second Line :
City : HARLINGEN
State : TX
Zip : 78550-0800
Country : US
Telephone Number : 832-870-2089
Fax Number :
Provider Business Practice Location Address
First Line : 3033 W ORANGE AVE
Second Line :
City : ANAHEIM
State : CA
Zip : 92804-3183
Country : US
Telephone Number : 832-870-2089
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/04/2020
Last Update Date : 07/01/2024

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