Healthcare Provider Details

I. General information

NPI: 1669170528
Provider Name (Legal Business Name): MAYOWA ADESINA DNP, PMHNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2023
Last Update Date: 10/08/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18484 US HIGHWAY 18 STE 210
APPLE VALLEY CA
92307-2319
US

IV. Provider business mailing address

24613 HUDSON ST
MORENO VALLEY CA
92551-6973
US

V. Phone/Fax

Practice location:
  • Phone: 760-946-9133
  • Fax: 760-946-9110
Mailing address:
  • Phone: 909-327-8360
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95024352
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: