Healthcare Provider Details

I. General information

NPI: 1235645391
Provider Name (Legal Business Name): JONATHAN AUDU FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/27/2017
Last Update Date: 03/25/2026
Certification Date: 03/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 PLAZA DR STE 170
FOLSOM CA
95630-4790
US

IV. Provider business mailing address

18411 CRENSHAW BLVD STE 210
TORRANCE CA
90504-5048
US

V. Phone/Fax

Practice location:
  • Phone: 916-351-9400
  • Fax:
Mailing address:
  • Phone: 213-448-4267
  • Fax: 310-304-4241

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95008262
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95008262
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: