Healthcare Provider Details

I. General information

NPI: 1336994532
Provider Name (Legal Business Name): SUNDAY OLALEKAN OLOWOOKERE SUDCC, CADC, MBA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2024
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21101 DALE EVANS PKWY
APPLE VALLEY CA
92307-9356
US

IV. Provider business mailing address

21101 DALE EVANS PKWY
APPLE VALLEY CA
92307-9356
US

V. Phone/Fax

Practice location:
  • Phone: 760-961-6600
  • Fax:
Mailing address:
  • Phone: 760-961-6759
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number13581
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: