Provider Demographics
NPI:1356822605
Name:OLUGBAMI, MAYOWA
Entity type:Individual
Prefix:
First Name:MAYOWA
Middle Name:
Last Name:OLUGBAMI
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 1:3020 STINE RD APT 4
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93309-5863
Mailing Address - Country:US
Mailing Address - Phone:661-863-7436
Mailing Address - Fax:
Practice Address - Street 1:602 H ST # 120
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93304-1368
Practice Address - Country:US
Practice Address - Phone:661-379-4451
Practice Address - Fax:661-215-5311
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-24
Last Update Date:2019-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)