1336152396 NPI number — DR. CELEDOR HUTTO AKINTUNDE MD

Table of content: DR. CELEDOR HUTTO AKINTUNDE MD (NPI 1336152396)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336152396 NPI number — DR. CELEDOR HUTTO AKINTUNDE MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AKINTUNDE
Provider First Name:
CELEDOR
Provider Middle Name:
HUTTO
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BOND
Provider Other First Name:
CELEDOR
Provider Other Middle Name:
HUTTO
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1336152396
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/16/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2960 CAMINO DIABLO STE 105
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WALNUT CREEK
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94597-3945
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-892-2695
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
70 BIRCH ALY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BEAVERCREEK
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45440-1479
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-892-2695
Provider Business Practice Location Address Fax Number:
415-458-2691
Provider Enumeration Date:
08/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207QA0401X , with the licence number:  2021-02486 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207QA0401X , with the licence number: 35.123232 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com