Healthcare Provider Details

I. General information

NPI: 1194243790
Provider Name (Legal Business Name): OLUWASEUN BOLADALE OGUNJIMI NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2017
Last Update Date: 03/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3401 W SUNFLOWER AVE STE 250
SANTA ANA CA
92704
US

IV. Provider business mailing address

3401 W SUNFLOWER AVE STE 250
SANTA ANA CA
92704-6948
US

V. Phone/Fax

Practice location:
  • Phone: 888-789-9585
  • Fax:
Mailing address:
  • Phone: 888-789-9585
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP95006480
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberNP95006480
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: