MEDICARE: BLESSING FADAKA 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	363LF0000X	Family Nurse Practitioner	95029208	CA

General Provider Information

NPI Number	:	1508391624
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BLESSING FADAKA FNP

Provider Business Mailing Address
First Line	:	72780 COUNTRY CLUB DR STE 205
Second Line	:
City	:	RANCHO MIRAGE
State	:	CA
Zip	:	92270-4150
Country	:	US
Telephone Number	:	760-834-7905
Fax Number	:	760-834-7901

Provider Business Practice Location Address
First Line	:	72780 COUNTRY CLUB DR STE 205
Second Line	:
City	:	RANCHO MIRAGE
State	:	CA
Zip	:	92270-4150
Country	:	US
Telephone Number	:	760-834-7905
Fax Number	:	760-834-7901

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

Provider Enumeration Date	:	04/26/2017
Last Update Date	:	02/10/2026

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