Provider Demographics
NPI:1518198423
Name:OGUNNIYI, ADEDAMOLA ADEOLA (MD)
Entity Type:Individual
Prefix:DR
First Name:ADEDAMOLA
Middle Name:ADEOLA
Last Name:OGUNNIYI
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 1:6526 OCEAN CREST DR
Mailing Address - Street 2:APT A314
Mailing Address - City:RANCHO PALOS VERDES
Mailing Address - State:CA
Mailing Address - Zip Code:90275-5466
Mailing Address - Country:US
Mailing Address - Phone:732-771-6583
Mailing Address - Fax:
Practice Address - Street 1:1000 W CARSON ST
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90502-2004
Practice Address - Country:US
Practice Address - Phone:310-222-3501
Practice Address - Fax:310-782-1763
Is Sole Proprietor?:No
Enumeration Date:2009-07-28
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CAA114461207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program