Provider Demographics
NPI:1699852871
Name:OLUSEGUN Z. SALAKO M.D. INC
Entity Type:Organization
Organization Name:OLUSEGUN Z. SALAKO M.D. INC
Other - Org Name:COMFORT MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PEDIATRIC SPECIALIST/MEDICAL DIRECT
Authorized Official - Prefix:DR
Authorized Official - First Name:THECLA
Authorized Official - Middle Name:N
Authorized Official - Last Name:MGBOJIRKWE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:562-218-6264
Mailing Address - Street 1:1951 PACIFIC AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90806-5321
Mailing Address - Country:US
Mailing Address - Phone:562-218-6264
Mailing Address - Fax:562-218-0745
Practice Address - Street 1:1951 PACIFIC AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90806-5321
Practice Address - Country:US
Practice Address - Phone:562-218-6264
Practice Address - Fax:562-218-0745
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2012-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X
CAA83572174400000X
CAG67118207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0098550Medicaid
CAGR0098551OtherMEDI-CAL
CAGR0098550Medicaid