Oluwole Oluseyi Olusola, M.D.

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

C159183 Issued in CA

Practice address

2008 N Garey Ave
Pomona, CA 91767-2722

Phone

(909) 623-6131

Fax

(909) 865-9281

NPI assigned

Jul 14, 2006

Last updated

Jan 22, 2019By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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.

• Tri-City Mental Health Authority

  • Community/Behavioral Health Agency
  • Pomona, CA
  • NPI 1346304920
  Medicare reassignment
• Tri-City Mental Health Center

  • Case Management Agency
  • Pomona, CA
  • NPI 1255651501
  NPD (past)
• Consolidated Behavioral Health Services, Inc

  • Clinical Social Worker
  • Evansville, IN
  • NPI 1669679296
  NPD (past)

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

{
    "created_epoch": "1152835200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1548115200000",
    "number": "1972529170",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "920 FREDERICA ST STE 407",
            "address_2": "P.O. BOX 1876",
            "city": "OWENSBORO",
            "state": "KY",
            "postal_code": "423013079",
            "telephone_number": "270-684-1077",
            "fax_number": "270-684-1339"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2008 N GAREY AVE",
            "city": "POMONA",
            "state": "CA",
            "postal_code": "917672722",
            "telephone_number": "909-623-6131",
            "fax_number": "909-865-9281"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OLUSOLA",
        "first_name": "OLUWOLE",
        "middle_name": "OLUSEYI",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-14",
        "last_updated": "2019-01-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "KY",
            "license": "30604",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "CA",
            "license": "C159183",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Bianca Oliver, PHARM.D
• Eric Brett Oliver, PA-C
• Angela Guadalupe Oliveros
• Christian Olsen
• Ingrid M Olsson, PA-C
• Alyssa Olvera
• Alyssa Olvera
• Ivonne Andrea Omana
• Michael Gregory Omoyele
• One Touch of Christ Evangelistic Ministries (One Touch Recovery Center)

• Psychiatry Physician in Pomona, CA
• Providers in Pomona, CA by specialty
• Psychiatry Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.