Healthcare Provider Details

I. General information

NPI: 1417739475
Provider Name (Legal Business Name): OLUWASEUN DORCAS FAGBE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/16/2023
Last Update Date: 05/13/2025
Certification Date: 05/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 ILENE ST
MARTINEZ CA
94553-2631
US

IV. Provider business mailing address

300 ILENE ST
MARTINEZ CA
94553-2631
US

V. Phone/Fax

Practice location:
  • Phone: 925-238-4887
  • Fax:
Mailing address:
  • Phone: 925-238-4887
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: