Healthcare Provider Details

I. General information

NPI: 1790313203
Provider Name (Legal Business Name): OLATOYOSI GRACE AKINROTIMI MMS MPH, PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2020
Last Update Date: 04/11/2025
Certification Date: 04/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

737 W CHILDS AVE
MERCED CA
95341-6805
US

IV. Provider business mailing address

1637 N 35TH AVE
MELROSE PARK IL
60160-1727
US

V. Phone/Fax

Practice location:
  • Phone: 866-682-4842
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number085008021
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA66267
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: