Healthcare Provider Details

I. General information

NPI: 1548574759
Provider Name (Legal Business Name): DEJI AKINLOSOTU CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2010
Last Update Date: 06/02/2023
Certification Date: 06/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 RENNER DR
FORTUNA CA
95540-3120
US

IV. Provider business mailing address

1337 S LOVERS LN
VISALIA CA
93292-5249
US

V. Phone/Fax

Practice location:
  • Phone: 707-725-7327
  • Fax:
Mailing address:
  • Phone: 559-733-7888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number95000700
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: