Provider Demographics
NPI:1922536028
Name:ADETORO, ADEBOYE TAIWO
Entity Type:Individual
Prefix:MR
First Name:ADEBOYE
Middle Name:TAIWO
Last Name:ADETORO
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 1:1402 S CARRIER PKWY APT 404
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75051-2810
Mailing Address - Country:US
Mailing Address - Phone:214-395-7229
Mailing Address - Fax:
Practice Address - Street 1:1402 S CARRIER PKWY APT 404
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75051-2810
Practice Address - Country:US
Practice Address - Phone:214-395-7229
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)