Individual provider Active NPI

Gbemisola Lawal

  • Surgery Physician
  • Colton, CA
National Provider Identifier
1104455351
Registry record updated Jul 17, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
51158 Issued in AL
Practice address
400 N Pepper Ave
Colton, CA 92324-1801
Phone
(909) 958-0100
NPI assigned
Apr 8, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 17, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Surgery Physician 208600000X 51158 AL Primary
Surgery Physician 208600000X A189114 CA

Addresses

Primary practice location

400 N Pepper Ave
Colton, CA 92324-1801

Mailing address

PO Box 1776
Vacaville, CA 95696-1776

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AL, CA2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20250829003512 AL Practitioner - General Surgery 2264933381 Reassigns benefits to 1 organization
I20250909001884 CA Practitioner - General Surgery 2264933381 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
General Surgery
Education
Other, 2020
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

4055 Valley View LN
Suite 400
Dallas, TX 75244-4910

4055 Valley View LN
Suite 400
Dallas, TX 75244-5071

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
51158ALMDSurgery Physician
A189114CAMDSurgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Signify Health Medical Associates of California, PC CurrentSince Jul 24, 2025 Accepting new patients
Signify Health, LLC CurrentSince Jul 24, 2025 Accepting new patients

Locations

4000 Eagle Point Corporate Dr
Birmingham, AL 35242
Phone (205) 317-0280

818 W 7th St
Ste 930
Los Angeles, CA 90017
Phone (800) 525-9202

4055 Valley View Ln
Ste 400
Dallas, TX 75244
Phone (469) 466-7037

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1586304000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1752710400000",
    "number": "1104455351",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1776",
            "city": "VACAVILLE",
            "state": "CA",
            "postal_code": "956961776"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 N PEPPER AVE",
            "city": "COLTON",
            "state": "CA",
            "postal_code": "923241801",
            "telephone_number": "909-958-0100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LAWAL",
        "first_name": "GBEMISOLA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-04-08",
        "last_updated": "2025-07-17",
        "certification_date": "2025-07-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "AL",
            "license": "51158",
            "primary": true
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "CA",
            "license": "A189114",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Colton, CA

Sources for this page

Verify at the official NPI Registry.