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NPI Code Detail

MEDICARE: MODUPEOLA OLAJUMOKE ADEDEJI

MEDICARE: MODUPEOLA OLAJUMOKE ADEDEJI
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
1261QM0801XMental Health Clinic/Center (Including Community Mental Health Center)

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1932186863
Entity Type Code : Organization
Provider Name (Legal Business Name) : MODUPEOLA OLAJUMOKE ADEDEJI
Provider Business Mailing Address
First Line : 530 SAN PEDRO AVE
Second Line :
City : SAN ANTONIO
State : TX
Zip : 78212-5006
Country : US
Telephone Number : 210-697-5700
Fax Number : 210-558-9032
Provider Business Practice Location Address
First Line : 530 SAN PEDRO AVE
Second Line :
City : SAN ANTONIO
State : TX
Zip : 78212-5006
Country : US
Telephone Number : 210-697-5700
Fax Number : 210-558-9032
Authorized Official
Title or Position : CEO
Name : MR. ADEDIRAN ADEDEJI
Credential :
Telephone Number : 210-697-5700
Provider Enumeration Date : 12/30/2005
Last Update Date : 09/27/2012

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Practice Location Address:
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78212-5006
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1568554756 — MATTHEW PAUL GIBBS M.D.
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530 SAN PEDRO AVE
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78212-5006
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1801068671 — PROGRESSIVE PATHOLOGY INC.
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Directions to “MODUPEOLA OLAJUMOKE ADEDEJI ” Practice Location

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