MEDICARE: MS. OLUWAPELUMI OLUKOTUN APRN, CCM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number
1	171W00000X	Contractor
2	173000000X	Legal Medicine
3	1744R1102X	Research Study Specialist
4	1744R1103X	Research Study Abstracter/Coder
5	174H00000X	Health Educator
6	174V00000X	Clinical Ethicist
7	246Y00000X	Health Information Specialist/Technologist
8	251B00000X	Case Management Agency	4217575
9	251E00000X	Home Health Agency
10	332100000X	Department of Veterans Affairs (VA) Pharmacy
11	332B00000X	Durable Medical Equipment & Medical Supplies
12	347C00000X	Private Vehicle
13	367A00000X	Advanced Practice Midwife
14	376G00000X	Nursing Home Administrator
15	171M00000X	Case Manager/Care Coordinator	4217575

General Provider Information

NPI Number	:	1265820278
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. OLUWAPELUMI OLUKOTUN APRN, CCM

Provider Business Mailing Address
First Line	:	PO BOX 558
Second Line	:
City	:	SAN LUIS REY
State	:	CA
Zip	:	92068-0558
Country	:	US
Telephone Number	:	571-400-8461
Fax Number	:	760-692-2750

Provider Business Practice Location Address
First Line	:	3646 OCEAN RANCH BLVD
Second Line	:
City	:	OCEANSIDE
State	:	CA
Zip	:	92056-2669
Country	:	US
Telephone Number	:	571-400-8461
Fax Number	:	760-692-2750

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/27/2014
Last Update Date	:	08/13/2020

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