Healthcare Provider Details

I. General information

NPI: 1053785899
Provider Name (Legal Business Name): FOLASADE OLAREWAJU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2015
Last Update Date: 06/23/2023
Certification Date: 06/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 PINE AVE STE 400
LONG BEACH CA
90802-3039
US

IV. Provider business mailing address

7121 CAPRICE CIR
LA PALMA CA
90623-1168
US

V. Phone/Fax

Practice location:
  • Phone: 562-285-1330
  • Fax:
Mailing address:
  • Phone: 714-221-6400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: