Provider Demographics
NPI:1083948830
Name:OYEWOLE, AYOADE MOSES
Entity Type:Individual
Prefix:
First Name:AYOADE
Middle Name:MOSES
Last Name:OYEWOLE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5506 BEARDSLEY LN
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95219-7142
Mailing Address - Country:US
Mailing Address - Phone:209-373-7051
Mailing Address - Fax:209-390-1882
Practice Address - Street 1:1031 N EL DORADO ST STE C
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95202-1303
Practice Address - Country:US
Practice Address - Phone:209-373-7051
Practice Address - Fax:209-390-1882
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-28
Last Update Date:2019-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)