Healthcare Provider Details

I. General information

NPI: 1326954918
Provider Name (Legal Business Name): OLUWATOSIN ONI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2026
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10284 MARAMA WAY
ELK GROVE CA
95757-5093
US

IV. Provider business mailing address

10284 MARAMA WAY
ELK GROVE CA
95757-5093
US

V. Phone/Fax

Practice location:
  • Phone: 270-320-5417
  • Fax:
Mailing address:
  • Phone: 270-320-5417
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2615PA
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: