1740708957 NPI number — ADEDEJI ASSOCIATES PLLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740708957 NPI number — ADEDEJI ASSOCIATES PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADEDEJI ASSOCIATES PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1740708957
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11212 STATE HWY 151
Provider Second Line Business Mailing Address:
SUITE 200 MEDICAL PLAZA 1
Provider Business Mailing Address City Name:
SAN ANTONIO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78251
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
210-339-2293
Provider Business Mailing Address Fax Number:
844-427-8169

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11212 STATE HIGHWAY 151
Provider Second Line Business Practice Location Address:
STE 200 MEDICAL PLAZA 1
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78251-4504
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-339-2293
Provider Business Practice Location Address Fax Number:
844-427-8169
Provider Enumeration Date:
09/07/2017

Additional Information

Authorized Official

Authorized Official Last Name:
ADEDEJI
Authorized Official First Name:
ADEBUKOLA
Authorized Official Middle Name:
A
Authorized Official Title or Position:
BUSINESS OWNER
Authorized Official Telephone Number:
210-339-2293

Provider Taxonomy Codes

  • Taxonomy code: 208600000X , with the licence number:  Q0719 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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