Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | D69359 | MD |
Y | 2080P0210X | Pediatric Nephrologist | A91917 | CA |
NPI | 1063695799 |
---|---|
Provider Name | Dr. Laide Adele Ajike Jinadu |
First Address | Madera, CA 93636-8761 |
Second Address | Madera, CA 93636-8761 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/12/2007 |
Last Update Date | 18/08/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1063695799 | (05) | CA |
418112300 | (05) | MD |