MEDICARE: MRS. ADEBOLA A KOKO FNP

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	95016000	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	95016000	OTHER	CA	NURSE PRACTITIONER LICENSE NUMBER

General Provider Information

NPI Number	:	1427652130
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ADEBOLA A KOKO FNP

Provider Business Mailing Address
First Line	:	23851 ALBERS ST
Second Line	:
City	:	WOODLAND HILLS
State	:	CA
Zip	:	91367-5809
Country	:	US
Telephone Number	:	833-935-6377
Fax Number	:	833-935-6377

Provider Business Practice Location Address
First Line	:	43875 WASHINGTON ST STE C
Second Line	:
City	:	PALM DESERT
State	:	CA
Zip	:	92211-8249
Country	:	US
Telephone Number	:	833-935-6377
Fax Number	:	833-935-6377

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

Provider Enumeration Date	:	11/23/2020
Last Update Date	:	07/07/2023

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