Provider Demographics
NPI:1467543769
Name:OLANIYAN, OMOBOLA ADEOLA (MD)
Entity Type:Individual
Prefix:DR
First Name:OMOBOLA
Middle Name:ADEOLA
Last Name:OLANIYAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9300 VALLEY CHILDRENS PL # SC05
Mailing Address - Street 2:
Mailing Address - City:MADERA
Mailing Address - State:CA
Mailing Address - Zip Code:93636-8761
Mailing Address - Country:US
Mailing Address - Phone:559-538-3070
Mailing Address - Fax:559-538-3071
Practice Address - Street 1:2497 HERNDON AVE STE 101
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93611-8977
Practice Address - Country:US
Practice Address - Phone:559-538-3070
Practice Address - Fax:559-538-3071
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC160272208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200246790AMedicaid
IN000000310634OtherANTHEM