Provider Demographics
NPI:1902087125
Name:FOLORUNSHO OVBUDE
Entity Type:Organization
Organization Name:FOLORUNSHO OVBUDE
Other - Org Name:ST JAMES MEDICAL CARE SERVICES INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FOLORUNSHO
Authorized Official - Middle Name:
Authorized Official - Last Name:OVBUDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-680-0715
Mailing Address - Street 1:425 W LA CADENA DR
Mailing Address - Street 2:SUITE 17
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92501
Mailing Address - Country:US
Mailing Address - Phone:951-680-0715
Mailing Address - Fax:909-433-9882
Practice Address - Street 1:425 W LA CADENA DR
Practice Address - Street 2:SUITE 17
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92501
Practice Address - Country:US
Practice Address - Phone:951-680-0715
Practice Address - Fax:909-433-9882
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-15
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA48331332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6044180001Medicare NSC