Healthcare Provider Details

I. General information

NPI: 1093977076
Provider Name (Legal Business Name): GBENGA AKINYEMI MSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2008
Last Update Date: 06/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31625 HIGH WAY 101 SALINAS VALLEY PSYCHIATRIC PROGRAM
SOLEDAD CA
93960
US

IV. Provider business mailing address

P O BOX 216404
SACRAMENTO CA
95821
US

V. Phone/Fax

Practice location:
  • Phone: 831-678-5500
  • Fax:
Mailing address:
  • Phone: 916-549-9009
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: