Healthcare Provider Details

I. General information

NPI: 1205167434
Provider Name (Legal Business Name): OBIANUJU L MAKINDE-AGU FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. OBIANUJU AGU

II. Dates (important events)

Enumeration Date: 01/28/2010
Last Update Date: 12/06/2024
Certification Date: 12/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2535 16TH ST STE 100
BAKERSFIELD CA
93301-3417
US

IV. Provider business mailing address

1691 THE ALAMEDA
SAN JOSE CA
95126-2203
US

V. Phone/Fax

Practice location:
  • Phone: 661-334-4400
  • Fax: 661-634-1040
Mailing address:
  • Phone: 408-795-3619
  • Fax: 408-287-0405

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number18069
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP18069
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: