Healthcare Provider Details

I. General information

NPI: 1780374975
Provider Name (Legal Business Name): AKINLOSOTU NURSING ANESTHESIA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2023
Last Update Date: 05/25/2023
Certification Date: 05/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 RENNER DR
FORTUNA CA
95540-3120
US

IV. Provider business mailing address

PO BOX 5486
ORANGE CA
92863-5486
US

V. Phone/Fax

Practice location:
  • Phone: 608-354-3559
  • Fax:
Mailing address:
  • Phone: 818-550-0900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. DEJI AKINLOSOTU
Title or Position: OWNER
Credential: CRNA
Phone: 608-354-3559