Healthcare Provider Details

I. General information

NPI: 1609573138
Provider Name (Legal Business Name): NIHINLOLA YEJIDE FASANYA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/15/2023
Last Update Date: 02/16/2023
Certification Date: 02/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1313 CUTTING BLVD
RICHMOND CA
94804
US

IV. Provider business mailing address

1313 CUTTING BLVD
RICHMOND CA
94804
US

V. Phone/Fax

Practice location:
  • Phone: 510-232-0874
  • Fax: 510-232-8652
Mailing address:
  • Phone: 510-232-0874
  • Fax: 510-232-8652

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: