Provider Demographics
NPI:1619766052
Name:OLARINDE, IMMANUEL OMOGORIOLA (MD)
Entity type:Individual
Prefix:
First Name:IMMANUEL
Middle Name:OMOGORIOLA
Last Name:OLARINDE
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CREIGHTON UNIVERSITY
Mailing Address - Street 2:3100 N. CENTRAL AVENUE
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:VALLEYWISE HEALTH
Practice Address - Street 2:2601 E ROOSEVELT ST
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85008
Practice Address - Country:US
Practice Address - Phone:602-344-5011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-02
Last Update Date:2025-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program