Provider Demographics
NPI:1619183811
Name:ABAYOMI A. ODUBELA, M.D., A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:ABAYOMI A. ODUBELA, M.D., A PROFESSIONAL CORPORATION
Other - Org Name:MURRIETA FAMILY MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ABAYOMI
Authorized Official - Middle Name:ADESINA
Authorized Official - Last Name:ODUBELA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:951-676-4221
Mailing Address - Street 1:PO BOX 972
Mailing Address - Street 2:
Mailing Address - City:SUN CITY
Mailing Address - State:CA
Mailing Address - Zip Code:92586-0972
Mailing Address - Country:US
Mailing Address - Phone:951-676-4221
Mailing Address - Fax:951-676-0032
Practice Address - Street 1:25470 MEDICAL CENTER DR STE 205
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92562-4901
Practice Address - Country:US
Practice Address - Phone:951-676-4221
Practice Address - Fax:951-676-0032
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA51039207R00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA=========OtherTIN