Provider Demographics
NPI:1821763590
Name:SHAFTER PEDIATRICS
Entity Type:Organization
Organization Name:SHAFTER PEDIATRICS
Other - Org Name:ELMO PEDIATRICS & FAMILY WALK-IN CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:AYODEJI
Authorized Official - Middle Name:ADETAYO
Authorized Official - Last Name:AYENI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:661-364-5244
Mailing Address - Street 1:P.O. BOX 22694
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93390-2694
Mailing Address - Country:US
Mailing Address - Phone:661-630-5274
Mailing Address - Fax:
Practice Address - Street 1:501 MUNZER ST
Practice Address - Street 2:SUITE C
Practice Address - City:SHAFTER
Practice Address - State:CA
Practice Address - Zip Code:93263-2042
Practice Address - Country:US
Practice Address - Phone:661-630-5274
Practice Address - Fax:661-630-5290
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SHAFTER PEDIATRICS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-08-13
Last Update Date:2023-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA552863OtherMEDICAL BOARD OF CALIFORNIA