Provider Demographics
NPI:1144313800
Name:OLUYEMISI S. AFUAPE, M.D., INC
Entity type:Organization
Organization Name:OLUYEMISI S. AFUAPE, M.D., INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:OLUYEMISI
Authorized Official - Middle Name:S
Authorized Official - Last Name:AFUAPE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-792-0717
Mailing Address - Street 1:50 ALESSANDRO PL.
Mailing Address - Street 2:STE 100
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91105
Mailing Address - Country:US
Mailing Address - Phone:626-792-0717
Mailing Address - Fax:626-792-3703
Practice Address - Street 1:50 ALESSANDRO PL.
Practice Address - Street 2:STE 100
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105
Practice Address - Country:US
Practice Address - Phone:626-792-0717
Practice Address - Fax:626-792-3703
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC2481028208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA=========Medicaid