Provider Demographics
NPI:1649895301
Name:UBAH, ADELAIDE OBIANUJU (MD)
Entity type:Individual
Prefix:MS
First Name:ADELAIDE
Middle Name:OBIANUJU
Last Name:UBAH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3875 W BEECHWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93711-0795
Mailing Address - Country:US
Mailing Address - Phone:008-492-4227
Mailing Address - Fax:
Practice Address - Street 1:121 BARBOZA ST
Practice Address - Street 2:
Practice Address - City:MENDOTA
Practice Address - State:CA
Practice Address - Zip Code:93640-1901
Practice Address - Country:US
Practice Address - Phone:516-572-5049
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-09
Last Update Date:2024-03-21
Deactivation Date:2022-01-18
Deactivation Code:
Reactivation Date:2022-02-22
Provider Licenses
StateLicense IDTaxonomies
CAA192395208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics