Healthcare Provider Details

I. General information

NPI: 1528523396
Provider Name (Legal Business Name): ABOSEDE OLUBUNMI OGUNKANMI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2019
Last Update Date: 02/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1411 E 31ST ST
OAKLAND CA
94602-1018
US

IV. Provider business mailing address

2101 PARKHURST ST
HAYWARD CA
94541-6675
US

V. Phone/Fax

Practice location:
  • Phone: 510-437-4918
  • Fax:
Mailing address:
  • Phone: 510-759-3651
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number681349
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License Number681349
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: