Provider Demographics
NPI:1922108877
Name:ODUBELA, ABAYOMI ADESINA (MD)
Entity Type:Individual
Prefix:DR
First Name:ABAYOMI
Middle Name:ADESINA
Last Name:ODUBELA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:YOMI
Other - Middle Name:ADESINA
Other - Last Name:ODUBELA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 972
Mailing Address - Street 2:
Mailing Address - City:SUN CITY
Mailing Address - State:CA
Mailing Address - Zip Code:92586-0972
Mailing Address - Country:US
Mailing Address - Phone:951-676-4221
Mailing Address - Fax:951-676-0032
Practice Address - Street 1:25470 MEDICAL CENTER DR STE 205
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92562
Practice Address - Country:US
Practice Address - Phone:951-676-4221
Practice Address - Fax:951-676-0032
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2018-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA51039207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A510390Medicaid
CA00A510391Medicaid
CA00A510390Medicaid
CA00A510391Medicaid