1871875344 NPI number — DR. OMONIYI OMOTOSO M.D., M.P.H., FAAP

Table of content: DR. OMONIYI OMOTOSO M.D., M.P.H., FAAP (NPI 1871875344)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871875344 NPI number — DR. OMONIYI OMOTOSO M.D., M.P.H., FAAP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
OMOTOSO
Provider First Name:
OMONIYI
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D., M.P.H., FAAP
Provider Gender Code:
M

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:
1871875344
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/06/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2920 INTERNATIONAL BOULEVARD
Provider Second Line Business Mailing Address:
NATIVE AMERICAN HEALTH CENTER - ADMINISTRATIVE OFFICE
Provider Business Mailing Address City Name:
OAKLAND
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94611
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
510-535-4400
Provider Business Mailing Address Fax Number:
510-535-8474

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2920 INTERNATIONAL BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OAKLAND
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94601-2228
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-535-4400
Provider Business Practice Location Address Fax Number:
510-535-8474
Provider Enumeration Date:
09/12/2011

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: 208000000X , with the licence number:  94033 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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