Healthcare Provider Details

I. General information

NPI: 1578455523
Provider Name (Legal Business Name): ADEMILOLA OLUFUNMIKE OYETUGA NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/16/2025
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1180 ROSECRANS ST
SAN DIEGO CA
92106-2660
US

IV. Provider business mailing address

1180 ROSECRANS ST
SAN DIEGO CA
92106-2660
US

V. Phone/Fax

Practice location:
  • Phone: 858-321-5372
  • Fax:
Mailing address:
  • Phone: 253-232-3876
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number95040536
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: