Healthcare Provider Details

I. General information

NPI: 1326605148
Provider Name (Legal Business Name): OLUWATOYIN MONSURAT OGUNJALE DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/28/2019
Last Update Date: 05/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9369 GREENBELT PL
RANCHO CUCAMONGA CA
91730-5662
US

IV. Provider business mailing address

9369 GREENBELT PL
RANCHO CUCAMONGA CA
91730-5662
US

V. Phone/Fax

Practice location:
  • Phone: 909-635-5627
  • Fax:
Mailing address:
  • Phone: 909-635-5627
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95011856
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: