Individual
BANKOLE SIMBO ASEBIOMO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3801 MIRANDA AVE, PALO ALTO, CA 94304-1207
(229) 391-4100
Mailing address
3041 SKY WATCH WAY, ROSEVILLE, CA 95747-9378
(916) 477-4944
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
045706
GA
207R00000X
Internal Medicine Physician
Primary
C163303
CA
207RI0200X
Infectious Disease Physician
045706
GA
208M00000X
Hospitalist Physician
0101242047
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000849329D
—
GA
05
—
1841301884
—
VA
01
—
P00417087
MEDICARE RAILROAD
VA
Enumeration date
08/31/2006
Last updated
04/28/2023
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