Provider Demographics
NPI:1861445470
Name:OMOLOLU, OLAYINKA TITILOLA (MD)
Entity Type:Individual
Prefix:DR
First Name:OLAYINKA
Middle Name:TITILOLA
Last Name:OMOLOLU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:OLAYINKA
Other - Middle Name:TITILOLA
Other - Last Name:LAJIDE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:5400 W HILLSDALE AVE
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93291-8222
Mailing Address - Country:US
Mailing Address - Phone:559-738-7557
Mailing Address - Fax:559-739-0278
Practice Address - Street 1:5400 W HILLSDALE AVE
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93291-8222
Practice Address - Country:US
Practice Address - Phone:559-738-7599
Practice Address - Fax:559-739-0278
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2016-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA84268207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACA171999Medicare PIN
CAAP455SMedicare PIN