Provider Demographics
NPI:1114938214
Name:IYABO DARAMOLA MD INC
Entity Type:Organization
Organization Name:IYABO DARAMOLA MD INC
Other - Org Name:CARING HEARTS MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:IYABO
Authorized Official - Middle Name:O
Authorized Official - Last Name:DARAMOLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:619-479-6767
Mailing Address - Street 1:PO BOX 675833
Mailing Address - Street 2:
Mailing Address - City:RANCHO SANTA FE
Mailing Address - State:CA
Mailing Address - Zip Code:92067-5833
Mailing Address - Country:US
Mailing Address - Phone:619-479-6767
Mailing Address - Fax:619-434-8840
Practice Address - Street 1:2401 REO DR
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92139-3025
Practice Address - Country:US
Practice Address - Phone:619-479-6767
Practice Address - Fax:619-434-8840
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-11
Last Update Date:2013-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA63633207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0098920Medicaid
CAG38901Medicare UPIN
CAGR0098920Medicaid