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Individual

MR. BABAJIDE ADETOKUNBO FAJEMISIN

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
PA-C

Contact information

Practice address
15791 BEAR VALLEY RD, HESPERIA, CA 92345-1746
(760) 949-1231
(877) 738-3841
Mailing address
625 FAIR OAKS AVE STE 270, SOUTH PASADENA, CA 91030-5801
(626) 346-2455
(626) 639-3005

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
PA20295
CA
363A00000X
Physician Assistant
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
EFF.10/21/13-COLTON
CA
05
EFF: 1/18/13
CA
05
EFF: 1/18/2013
CA
05
EFF: 1/24/2013
CA
05
EFF:10/21/13-VICTORV
CA
05
EFF:10/29/12
CA
01
P01282519/DU4034
RAILROAD MEDICARE-ADELANTO
CA
01
P01288530/DU5182
RAILROAD MEDICARE-COLTON/VICTORVILLE
CA
Enumeration date
09/11/2009
Last updated
11/27/2023
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