Provider Demographics
NPI:1891535365
Name:SANYAOLU, STEPHEN
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:
Last Name:SANYAOLU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:STEPHEN
Other - Middle Name:
Other - Last Name:SANYAOLU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PAUL BAPELA
Mailing Address - Street 1:5129 LONE TREE WAY
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:CA
Mailing Address - Zip Code:94531-8484
Mailing Address - Country:US
Mailing Address - Phone:925-418-2115
Mailing Address - Fax:
Practice Address - Street 1:5129 LONE TREE WAY
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:CA
Practice Address - Zip Code:94531-8484
Practice Address - Country:US
Practice Address - Phone:925-207-6926
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-30
Last Update Date:2024-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA25652J1343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)