Provider Demographics
NPI:1043183403
Name:EVIDENCE HEALTH
Entity type:Organization
Organization Name:EVIDENCE HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:OLUWABUNMI
Authorized Official - Middle Name:D
Authorized Official - Last Name:ADEBAYO
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:248-252-2925
Mailing Address - Street 1:12464 BENTON DR UNIT 2
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91739-8097
Mailing Address - Country:US
Mailing Address - Phone:248-252-2925
Mailing Address - Fax:
Practice Address - Street 1:12464 BENTON DR UNIT 2
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91739-8097
Practice Address - Country:US
Practice Address - Phone:248-252-2925
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-23
Last Update Date:2025-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SF0001XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistFamily HealthGroup - Single Specialty