Active NPI
Olusegun Olayele III
- Durable Medical Equipment & Medical Supplies
- San Bernardino, CA
National Provider Identifier
1083833404
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Durable Medical Equipment & Medical Supplies
- License
- 46159
- Practice address
- 435 Orange Show LN
Suite 102
San Bernardino, CA 92408-2015 - Phone
- (909) 888-2966
- Fax
- (909) 888-5322
- NPI assigned
- Apr 24, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | 46159 | CA | Primary |
Addresses
Primary practice location
435 Orange Show LN
Suite 102
San Bernardino, CA 92408-2015
Mailing address
435 Orange Show LN
Suite 102
San Bernardino, CA 92408-2015
Phone (909) 888-2966
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 46159 | CA | MD | Marriage & Family Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1177372800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1206316800000",
"number": "1083833404",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "435 ORANGE SHOW LN",
"address_2": "SUITE 102",
"city": "SAN BERNARDINO",
"state": "CA",
"postal_code": "924082015",
"telephone_number": "909-888-2966",
"fax_number": "909-888-5322"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "435 ORANGE SHOW LN",
"address_2": "SUITE 102",
"city": "SAN BERNARDINO",
"state": "CA",
"postal_code": "924082015",
"telephone_number": "909-888-2966",
"fax_number": "909-888-5322"
}
],
"practiceLocations": [],
"basic": {
"last_name": "OLAYELE",
"first_name": "OLUSEGUN",
"name_suffix": "III",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-04-24",
"last_updated": "2008-03-24",
"status": "A"
},
"taxonomies": [
{
"code": "332B00000X",
"taxonomy_group": "",
"desc": "Durable Medical Equipment & Medical Supplies",
"state": "CA",
"license": "46159",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Bernardino, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 24, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.