Provider Demographics
NPI:1962255661
Name:PERIDOT HEALTH
Entity type:Organization
Organization Name:PERIDOT HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:OLOLADE
Authorized Official - Middle Name:OLUWATOYIN
Authorized Official - Last Name:OLADIMEJI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:190-394-4986
Mailing Address - Street 1:PO BOX 21438
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93390-1438
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:221 ELMO HWY STE 300
Practice Address - Street 2:
Practice Address - City:MC FARLAND
Practice Address - State:CA
Practice Address - Zip Code:93250-9528
Practice Address - Country:US
Practice Address - Phone:903-944-9868
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PERIDOT HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-04-10
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care