Provider Demographics
NPI:1922286343
Name:ADEKAYODE, PETER ADEBAYO
Entity Type:Individual
Prefix:MR
First Name:PETER
Middle Name:ADEBAYO
Last Name:ADEKAYODE
Suffix:
Gender:M
Credentials:
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 11526
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92711-1526
Mailing Address - Country:US
Mailing Address - Phone:714-834-6807
Mailing Address - Fax:714-567-7633
Practice Address - Street 1:1300 S GRAND AVE
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-4434
Practice Address - Country:US
Practice Address - Phone:714-834-6807
Practice Address - Fax:714-567-7633
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-07
Last Update Date:2008-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator