Healthcare Provider Details

I. General information

NPI: 1538979166
Provider Name (Legal Business Name): ABIOLA OLUFUNLAYO OLADOKE PHD, MSHNFM, CLT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/07/2025
Last Update Date: 08/11/2025
Certification Date: 08/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1447 W GRAND AVE
GROVER BEACH CA
93433-2250
US

IV. Provider business mailing address

110 MARY AVENUE SUITE 2298
NIPOMO CA
93444
US

V. Phone/Fax

Practice location:
  • Phone: 805-867-7298
  • Fax:
Mailing address:
  • Phone: 805-867-7298
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code172M00000X
TaxonomyMechanotherapist
License Number
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number StateCA
# 5
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: