Healthcare Provider Details

I. General information

NPI: 1700773819
Provider Name (Legal Business Name): PARAGON CITADEL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2025
Last Update Date: 03/25/2026
Certification Date: 03/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2516 E UNIVERSITY DR
PHOENIX AZ
85034-6915
US

IV. Provider business mailing address

2516 E UNIVERSITY DR
PHOENIX AZ
85034-6915
US

V. Phone/Fax

Practice location:
  • Phone: 404-980-7137
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: OLUWAKEMI OGUNLEYE
Title or Position: OWNER
Credential:
Phone: 214-646-1606