Provider Demographics
NPI:1093057648
Name:BAMGBOSE, OLUSINMI MOTUNROLA (MD)
Entity Type:Individual
Prefix:DR
First Name:OLUSINMI
Middle Name:MOTUNROLA
Last Name:BAMGBOSE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:401 PARNASSUS AVE
Mailing Address - Street 2:BOX 0984
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94143-2211
Mailing Address - Country:US
Mailing Address - Phone:415-476-7000
Mailing Address - Fax:
Practice Address - Street 1:401 PARNASSUS AVE
Practice Address - Street 2:BOX 0984-RTP
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94143-0984
Practice Address - Country:US
Practice Address - Phone:415-476-7577
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-21
Last Update Date:2016-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1320592084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry