Provider Demographics
NPI:1700950151
Name:OLUWAFEMI ADEYEMO,M.D PROFESSIONAL MEDICAL CORPORATION
Entity Type:Organization
Organization Name:OLUWAFEMI ADEYEMO,M.D PROFESSIONAL MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:OLUWAFEMI
Authorized Official - Middle Name:A
Authorized Official - Last Name:ADEYEMO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:951-492-0728
Mailing Address - Street 1:PO BOX 358
Mailing Address - Street 2:
Mailing Address - City:SAN JACINTO
Mailing Address - State:CA
Mailing Address - Zip Code:92581-0358
Mailing Address - Country:US
Mailing Address - Phone:951-492-0728
Mailing Address - Fax:951-332-8245
Practice Address - Street 1:540 N SAN JACINTO ST
Practice Address - Street 2:SUITE C
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92543-3154
Practice Address - Country:US
Practice Address - Phone:951-492-0728
Practice Address - Fax:951-332-8245
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-19
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA86706261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A867061Medicare ID - Type Unspecified