Provider Demographics
NPI:1215975115
Name:OREDUGBA, OLU (MD)
Entity type:Individual
Prefix:DR
First Name:OLU
Middle Name:
Last Name:OREDUGBA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8540 S SEPULVEDA BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045
Mailing Address - Country:US
Mailing Address - Phone:310-671-3148
Mailing Address - Fax:310-671-0878
Practice Address - Street 1:575 E HARDY ST
Practice Address - Street 2:SUITE #104
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90301-4036
Practice Address - Country:US
Practice Address - Phone:310-671-3148
Practice Address - Fax:310-671-0878
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2022-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG39345207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G393450Medicaid
CA390007978OtherRAILROAD MEDICARE
CAA89681Medicare UPIN
CA00G393450Medicaid
CAWG39345BMedicare PIN