Healthcare Provider Details

I. General information

NPI: 1497370548
Provider Name (Legal Business Name): WHITNEY I OBISANYA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2020
Last Update Date: 07/08/2025
Certification Date: 07/08/2025
Deactivation Date: 04/28/2023
Reactivation Date: 05/22/2023

III. Provider practice location address

160 E VIRGINIA ST STE 280
SAN JOSE CA
95112-5817
US

IV. Provider business mailing address

160 E VIRGINIA ST STE 280
SAN JOSE CA
95112-5817
US

V. Phone/Fax

Practice location:
  • Phone: 408-938-2113
  • Fax:
Mailing address:
  • Phone: 408-938-2113
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: