Provider Demographics
NPI:1922302173
Name:ADETOYE, BENJAMIN ADEDOTUN (MA)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:ADEDOTUN
Last Name:ADETOYE
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4000 E CHARLESTON BLVD BLDG SUITE230
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89104-6659
Mailing Address - Country:US
Mailing Address - Phone:702-968-5000
Mailing Address - Fax:702-968-5050
Practice Address - Street 1:4000 E CHARLESTON BLVD STE 230
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89104-6682
Practice Address - Country:US
Practice Address - Phone:702-968-5000
Practice Address - Fax:702-968-5050
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-03
Last Update Date:2019-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner