Healthcare Provider Details

I. General information

NPI: 1063981496
Provider Name (Legal Business Name): MR. HAKEEM MICHAEL WATKINS-OLADUNJOYE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2018
Last Update Date: 05/09/2026
Certification Date: 05/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6620 VIA DEL ORO
SAN JOSE CA
95119-1452
US

IV. Provider business mailing address

4401 CENTRAL AVE APT 44
FREMONT CA
94536-5845
US

V. Phone/Fax

Practice location:
  • Phone: 408-284-5265
  • Fax:
Mailing address:
  • Phone: 408-660-0701
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT128069
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: