Provider Demographics
NPI:1871630640
Name:GBOLAHAN OGUNBIYI
Entity Type:Organization
Organization Name:GBOLAHAN OGUNBIYI
Other - Org Name:D&G MEDICAL EQUIPMENT & SUPPLIES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:AFIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-608-1262
Mailing Address - Street 1:923 W FOOTHILL BLVD
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-3729
Mailing Address - Country:US
Mailing Address - Phone:909-608-1262
Mailing Address - Fax:909-608-1284
Practice Address - Street 1:923 W FOOTHILL BLVD
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-3729
Practice Address - Country:US
Practice Address - Phone:909-608-1262
Practice Address - Fax:909-608-1284
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5984160001Medicare NSC