Healthcare Provider Details

I. General information

NPI: 1225606668
Provider Name (Legal Business Name): OLATUNDE AKINWALE PMHNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2021
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2051 CUSHING RD
SAN DIEGO CA
92106-6173
US

IV. Provider business mailing address

550 POPE AVE
FORT LEAVENWORTH KS
66027-2332
US

V. Phone/Fax

Practice location:
  • Phone: 619-524-5717
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95017500
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: