Organization
MODUPEOLA OLAJUMOKE ADEDEJI
Active
Other names
La Paz Community Health Center
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ADEDIRAN ADEDEJI (CEO)
(210) 697-5700
Entity
Organization
Contact information
Practice address
530 SAN PEDRO AVE, SAN ANTONIO, TX 78212-5006
(210) 697-5700
(210) 558-9032
Mailing address
530 SAN PEDRO AVE, SAN ANTONIO, TX 78212-5006
(210) 697-5700
(210) 558-9032
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
021375301
—
TX
Enumeration date
12/30/2005
Last updated
09/27/2012
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