Healthcare Provider Details

I. General information

NPI: 1609730670
Provider Name (Legal Business Name): WILSON OLAKUNLE OJO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/12/2025
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10330 PIONEER BLVD STE 215
SANTA FE SPRINGS CA
90670-8277
US

IV. Provider business mailing address

12619 AVALON BLVD
LOS ANGELES CA
90061-2727
US

V. Phone/Fax

Practice location:
  • Phone: 562-402-0677
  • Fax: 323-544-0967
Mailing address:
  • Phone: 323-757-1881
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95036985
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number95263710
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: