Provider Demographics
NPI:1548318165
Name:SAMMY OGUNLEYE
Entity type:Organization
Organization Name:SAMMY OGUNLEYE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:SAMMY
Authorized Official - Middle Name:S
Authorized Official - Last Name:OGUNLEYE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-885-2460
Mailing Address - Street 1:688 N ARROWHEAD AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92401-1144
Mailing Address - Country:US
Mailing Address - Phone:909-885-2460
Mailing Address - Fax:909-556-1368
Practice Address - Street 1:688 N ARROWHEAD AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92401-1144
Practice Address - Country:US
Practice Address - Phone:909-885-2460
Practice Address - Fax:909-556-1368
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA46256332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5915030001Medicare NSC