Provider Demographics
NPI:1699002519
Name:OLORUNSOLA, OLUFOLADARE GABRIEL (MD)
Entity Type:Individual
Prefix:DR
First Name:OLUFOLADARE
Middle Name:GABRIEL
Last Name:OLORUNSOLA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 6102
Mailing Address - Street 2:
Mailing Address - City:NOVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94948-6102
Mailing Address - Country:US
Mailing Address - Phone:415-884-3415
Mailing Address - Fax:415-883-0877
Practice Address - Street 1:1101 VAN NESS AVE FL 3
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94109-6919
Practice Address - Country:US
Practice Address - Phone:415-600-3232
Practice Address - Fax:415-447-6335
Is Sole Proprietor?:No
Enumeration Date:2009-11-13
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1151672085R0202X, 2085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1699002519Medicaid
CACA154595Medicare PIN
CACA154596Medicare PIN
CACA154594Medicare PIN