Basic Information
| Provider Information | |||||||||
| NPI: | 1679795280 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ADEWUSI | ||||||||
| FirstName: | ADEDOTUN | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | 3687 MT DIABLO BLVD | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | LAFAYETTE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945493717 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9168546975 | ||||||||
| FaxNumber: | 9168546844 | ||||||||
| Practice Location | |||||||||
| Address1: | 3901 LONE TREE WAY | ||||||||
| Address2: | |||||||||
| City: | ANTIOCH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945096200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9257561192 | ||||||||
| FaxNumber: | 9257797220 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/03/2007 | ||||||||
| LastUpdateDate: | 01/31/2017 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208M00000X | MD442593 | PA | N | Allopathic & Osteopathic Physicians | Hospitalist | 207R00000X | MD442593 | PA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208000000X | MD442593 | PA | N | Allopathic & Osteopathic Physicians | Pediatrics | 208M00000X | 249539 | NY | N | Allopathic & Osteopathic Physicians | Hospitalist | 207R00000X | 249539 | NY | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208000000X | 249539 | NY | N | Allopathic & Osteopathic Physicians | Pediatrics | 208M00000X | C135329 | CA | Y | Allopathic & Osteopathic Physicians | Hospitalist | 207R00000X | C135329 | CA | N | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.