Healthcare Provider Details

I. General information

NPI: 1992416812
Provider Name (Legal Business Name): MR. FRANKLYN OKHALE DIRISU
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2022
Last Update Date: 05/16/2025
Certification Date: 05/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1119 E MONTE VISTA AVE
VACAVILLE CA
95688-3009
US

IV. Provider business mailing address

355 TUOLUMNE ST STE 1400
VALLEJO CA
94590-5700
US

V. Phone/Fax

Practice location:
  • Phone: 707-469-4610
  • Fax: 707-448-1119
Mailing address:
  • Phone: 707-553-5331
  • Fax: 707-553-5840

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: