Individual provider Active NPI

Oluwatoyosi Dada Omojaro, M.D.

  • Pediatrics Physician
  • Glendale, AZ
National Provider Identifier
1750608311
Registry record updated Nov 19, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
58434 Issued in AZ
Practice address
5555 W Thunderbird Rd
Glendale, AZ 85306-4622
Phone
(602) 865-5555
NPI assigned
Apr 22, 2010
Last updated
Nov 19, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 19, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X NU
Pediatrics Physician 208000000X 58434 AZ Primary

Addresses

Primary practice location

5555 W Thunderbird Rd
Glendale, AZ 85306-4622

Mailing address

5555 W Thunderbird Rd
Glendale, AZ 85306-4622
Phone (602) 865-5555

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ
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 1

Enrollment IDStateProvider typePAC IDDetails
I20251003001579 AZ Practitioner - Pediatric Medicine 7719129741 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Pediatric Medicine
Education
Other, 2009
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

1278 S Soho LN
Chandler, AZ 85286-1442

525 W Brown Rd
Mesa, AZ 85201-3202

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
58434AZMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Banner Physician Super Specialists Arizona LLC CurrentSince Sep 24, 2025 Accepting new patients
Banner Physician Super Specialists Arizona LLC CurrentSince Sep 24, 2025 Accepting new patients

Locations

5555 W Thunderbird Rd
Glendale, AZ 85306
Phone (602) 588-5555

1432 S Dobson Rd
Ste 301
Mesa, AZ 85202
Phone (480) 412-7120

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1271894400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1763510400000",
    "number": "1750608311",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5555 W THUNDERBIRD RD",
            "city": "GLENDALE",
            "state": "AZ",
            "postal_code": "853064622",
            "telephone_number": "602-865-5555"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5555 W THUNDERBIRD RD",
            "city": "GLENDALE",
            "state": "AZ",
            "postal_code": "853064622",
            "telephone_number": "602-865-5555"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OMOJARO",
        "first_name": "OLUWATOYOSI",
        "middle_name": "DADA",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-04-22",
        "last_updated": "2025-11-19",
        "certification_date": "2025-11-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "AZ",
            "license": "58434",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Glendale, AZ

Sources for this page

Verify at the official NPI Registry.