Basic Information
| Provider Information | |||||||||
| NPI: | 1639512239 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ADEWOLE | ||||||||
| FirstName: | VIRGINIA | ||||||||
| MiddleName: | ADESOLA | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2215 W ROSECRANS AVE STE 22 | ||||||||
| Address2: | |||||||||
| City: | COMPTON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 902223856 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | |||||||||
| FaxNumber: | 4243388984 | ||||||||
| Practice Location | |||||||||
| Address1: | 12021 WILMINGTON AVE | ||||||||
| Address2: | BLDG 11 STE. 1000 | ||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900593019 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4245296755 | ||||||||
| FaxNumber: | 4243388984 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/12/2013 | ||||||||
| LastUpdateDate: | 05/06/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/06/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | A163226 | CA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.