Active NPI
Lawal Abiodun Ibrahim-Balogun
- Durable Medical Equipment & Medical Supplies
- San Bernardino, CA
National Provider Identifier
1669640082
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Durable Medical Equipment & Medical Supplies
- License
- 48762
- Practice address
- 1525 N D St
Suite 14
San Bernardino, CA 92405-4722 - Phone
- (909) 386-3657
- Fax
- (909) 388-9173
- NPI assigned
- Feb 19, 2008
- 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 | 48762 | CA | Primary |
Addresses
Primary practice location
1525 N D St
Suite 14
San Bernardino, CA 92405-4722
Mailing address
1525 N D St
Suite 14
San Bernardino, CA 92405-4722
Phone (909) 386-3657
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 |
|---|---|---|---|
| 48762 | CA | MD | Durable Medical Equipment & Medical Supplies |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1203379200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1299024000000",
"number": "1669640082",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1525 N D ST",
"address_2": "SUITE 14",
"city": "SAN BERNARDINO",
"state": "CA",
"postal_code": "924054722",
"telephone_number": "909-386-3657",
"fax_number": "909-388-9173"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1525 N D ST",
"address_2": "SUITE 14",
"city": "SAN BERNARDINO",
"state": "CA",
"postal_code": "924054722",
"telephone_number": "909-386-3657",
"fax_number": "909-388-9173"
}
],
"practiceLocations": [],
"basic": {
"last_name": "IBRAHIM-BALOGUN",
"first_name": "LAWAL",
"middle_name": "ABIODUN",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-02-19",
"last_updated": "2011-03-02",
"status": "A"
},
"taxonomies": [
{
"code": "332B00000X",
"taxonomy_group": "",
"desc": "Durable Medical Equipment & Medical Supplies",
"state": "CA",
"license": "48762",
"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 2, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.