NPIMap

Organization Active NPI

Babatunde a. Eboreime, M.D., Inc.

  • Specialist
  • Pasadena, CA
National Provider Identifier
1184049488
Registry record updated Feb 23, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
G29988 Issued in CA
Legal business name
BABATUNDE A. EBOREIME, M.D., INC.
Practice address
2595 E Washington Blvd
Suite 105
Pasadena, CA 91107-1409
Phone
(626) 791-4692
Fax
(626) 791-7699
NPI assigned
Feb 23, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 23, 2014

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

Authorized official

Name
Babatunde A. Eboreime, M.D.
Title
Owner
Phone
(626) 791-4692

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193400000X SINGLE SPECIALTY GROUP 174400000X G29988 CA Primary

Addresses

Primary practice location

2595 E Washington Blvd
Suite 105
Pasadena, CA 91107-1409

Mailing address

2595 E Washington Blvd
Suite 105
Pasadena, CA 91107-1409
Phone (626) 791-4692

Other identifiers 1

IdentifierTypeStateIssuer
009299880MedicaidCA

National Provider Directory

National Provider Directory

Locations

2595 E Washington Blvd
Ste 105
Pasadena, CA 91107
Phone (626) 791-4692

NPI Registry JSON

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

{
    "created_epoch": "1393113600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1393113600000",
    "number": "1184049488",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2595 E WASHINGTON BLVD",
            "address_2": "SUITE 105",
            "city": "PASADENA",
            "state": "CA",
            "postal_code": "911071409",
            "telephone_number": "626-791-4692",
            "fax_number": "626-791-7699"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2595 E WASHINGTON BLVD",
            "address_2": "SUITE 105",
            "city": "PASADENA",
            "state": "CA",
            "postal_code": "911071409",
            "telephone_number": "626-791-4692",
            "fax_number": "626-791-7699"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BABATUNDE A. EBOREIME, M.D., INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-02-23",
        "last_updated": "2014-02-23",
        "status": "A",
        "authorized_official_last_name": "EBOREIME",
        "authorized_official_first_name": "BABATUNDE",
        "authorized_official_middle_name": "A.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "626-791-4692",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "CA",
            "license": "G29988",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "009299880",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Pasadena, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 23, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.