Provider Demographics
NPI:1073547220
Name:ADE OSIBAMIRO MD INC
Entity type:Organization
Organization Name:ADE OSIBAMIRO MD INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ABISOLA
Authorized Official - Middle Name:ALL
Authorized Official - Last Name:OSIBAMIRO-SEDUN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-847-1321
Mailing Address - Street 1:2637 E CARSON ST
Mailing Address - Street 2:
Mailing Address - City:CARSON
Mailing Address - State:CA
Mailing Address - Zip Code:90810-1508
Mailing Address - Country:US
Mailing Address - Phone:310-847-1321
Mailing Address - Fax:310-847-1825
Practice Address - Street 1:2637 E CARSON ST
Practice Address - Street 2:
Practice Address - City:CARSON
Practice Address - State:CA
Practice Address - Zip Code:90810-1508
Practice Address - Country:US
Practice Address - Phone:310-847-1321
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-11
Last Update Date:2025-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA64972207L00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A649720Medicaid
CAW18157AMedicare PIN
CA00A649720Medicaid
CABK740Medicare PIN