Provider Demographics
NPI:1851378236
Name:DARAMOLA, IYABO O (MD)
Entity Type:Individual
Prefix:
First Name:IYABO
Middle Name:O
Last Name:DARAMOLA
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:PO BOX 675833
Mailing Address - Street 2:
Mailing Address - City:RANCHO SANTA FE
Mailing Address - State:CA
Mailing Address - Zip Code:92067-5833
Mailing Address - Country:US
Mailing Address - Phone:619-489-6767
Mailing Address - Fax:619-434-8840
Practice Address - Street 1:2401 REO DR
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92139
Practice Address - Country:US
Practice Address - Phone:619-479-6767
Practice Address - Fax:619-434-3380
Is Sole Proprietor?:No
Enumeration Date:2005-12-28
Last Update Date:2013-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA463633207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A636330Medicaid
CA00A636330Medicaid
CAA63633Medicare ID - Type Unspecified