Provider Demographics
NPI:1205152139
Name:ADEGBENGA A ADETOLA M D INC
Entity type:Organization
Organization Name:ADEGBENGA A ADETOLA M D INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:ADETOLA
Authorized Official - Middle Name:
Authorized Official - Last Name:ADEGBENGA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-631-2838
Mailing Address - Street 1:3737 MARTIN LUTHER KING JR BLVD STE 400
Mailing Address - Street 2:
Mailing Address - City:LYNWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90262-3542
Mailing Address - Country:US
Mailing Address - Phone:310-631-2838
Mailing Address - Fax:310-632-4701
Practice Address - Street 1:3737 MARTIN LUTHER KING JR BLVD STE 400
Practice Address - Street 2:
Practice Address - City:LYNWOOD
Practice Address - State:CA
Practice Address - Zip Code:90262-3542
Practice Address - Country:US
Practice Address - Phone:310-631-2838
Practice Address - Fax:310-632-4701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-16
Last Update Date:2013-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty