Organization Name: | ADE OSIBAMIRO MD INC |
NPI Number: | 1073547220 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | ADE OSIBAMIRO (PRESIDENT) |
Mailing Address: | 2637 E Carson St Carson |
State: | CA US |
Postal Code: | 908101508 |
Phone Number: | 3108471321 |
Fax Number: | |
NPI Enumeration Date: | 07/11/2006 |
NPI Last Update Date: | 04/30/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | A64972 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | CA |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |