Healthcare Provider Details

I. General information

NPI: 1124545645
Provider Name (Legal Business Name): TEMITAYO OLAGBEMI RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2017
Last Update Date: 06/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

446 ALTA RD # 5300
SAN DIEGO CA
92158-3018
US

IV. Provider business mailing address

446 ALTA RD
SAN DIEGO CA
92158-0001
US

V. Phone/Fax

Practice location:
  • Phone: 619-210-0385
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95011030
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number95075817
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: