Provider Demographics
NPI:1467969485
Name:ASAFA, OLUSOLA MEMUD (PA-C)
Entity Type:Individual
Prefix:
First Name:OLUSOLA
Middle Name:MEMUD
Last Name:ASAFA
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2800 LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:OROVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95966-5961
Mailing Address - Country:US
Mailing Address - Phone:530-534-7500
Mailing Address - Fax:530-534-0210
Practice Address - Street 1:2800 LINCOLN ST
Practice Address - Street 2:
Practice Address - City:OROVILLE
Practice Address - State:CA
Practice Address - Zip Code:95966-5961
Practice Address - Country:US
Practice Address - Phone:530-534-7500
Practice Address - Fax:530-534-0210
Is Sole Proprietor?:No
Enumeration Date:2017-12-29
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant