Healthcare Provider Details

I. General information

NPI: 1174223747
Provider Name (Legal Business Name): KAFAYAT ADEOTI ADEBIYI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/03/2023
Last Update Date: 10/11/2026
Certification Date: 10/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 H ST STE 120
SACRAMENTO CA
95814-1817
US

IV. Provider business mailing address

3900 5TH AVE STE 300
SAN DIEGO CA
92103-3138
US

V. Phone/Fax

Practice location:
  • Phone: 310-431-9372
  • Fax: 855-430-2751
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95034807
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: