Healthcare Provider Details

I. General information

NPI: 1538748520
Provider Name (Legal Business Name): FEHINTOLU GBEMISOLA BADA NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: FEHINTOLU GBEMISOLA BADA NP

II. Dates (important events)

Enumeration Date: 04/06/2021
Last Update Date: 03/18/2026
Certification Date: 03/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 E PALMDALE BLVD
PALMDALE CA
93550-4598
US

IV. Provider business mailing address

43923 SPRING ST
LANCASTER CA
93536-2453
US

V. Phone/Fax

Practice location:
  • Phone: 818-654-3887
  • Fax: 818-975-5061
Mailing address:
  • Phone: 818-744-7239
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95017080
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number95017080
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: