Provider Demographics
NPI:1871875344
Name:OMOTOSO, OMONIYI (MD, MPH, FAAP)
Entity type:Individual
Prefix:DR
First Name:OMONIYI
Middle Name:
Last Name:OMOTOSO
Suffix:
Gender:M
Credentials:MD, MPH, FAAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2920 INTERNATIONAL BOULEVARD
Mailing Address - Street 2:NATIVE AMERICAN HEALTH CENTER - ADMINISTRATIVE OFFICE
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94611
Mailing Address - Country:US
Mailing Address - Phone:510-535-4400
Mailing Address - Fax:510-535-8474
Practice Address - Street 1:2920 INTERNATIONAL BLVD
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94601-2228
Practice Address - Country:US
Practice Address - Phone:510-535-4400
Practice Address - Fax:510-535-8474
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-12
Last Update Date:2024-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA94033208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty