Provider Demographics
NPI:1740001825
Name:ADEBAYO, OLUFEMI (HOME CARE PROVIDER)
Entity type:Individual
Prefix:
First Name:OLUFEMI
Middle Name:
Last Name:ADEBAYO
Suffix:
Gender:M
Credentials:HOME CARE PROVIDER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15824 SNOWY PEAK LANE, FONTANA, CA 92336
Mailing Address - Street 2:222 N. MOUNTAIN AVE, SUITE 210-A
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786
Mailing Address - Country:US
Mailing Address - Phone:626-252-5674
Mailing Address - Fax:
Practice Address - Street 1:222 N MOUNTAIN AVE STE 210A
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-5714
Practice Address - Country:US
Practice Address - Phone:626-252-5674
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-21
Last Update Date:2024-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00008224376G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376G00000XNursing Service Related ProvidersNursing Home Administrator