Provider Demographics
NPI:1952965139
Name:MAYOWA OLUGBAMI
Entity type:Organization
Organization Name:MAYOWA OLUGBAMI
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MAYOWA
Authorized Official - Middle Name:
Authorized Official - Last Name:OLUGBAMI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:661-379-4451
Mailing Address - Street 1:PO BOX 10792
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93389-0792
Mailing Address - Country:US
Mailing Address - Phone:661-863-7436
Mailing Address - Fax:
Practice Address - Street 1:602 H ST # 120
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93304-1368
Practice Address - Country:US
Practice Address - Phone:661-379-4451
Practice Address - Fax:661-215-5311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-23
Last Update Date:2019-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)