Healthcare Provider Details

I. General information

NPI: 1992330492
Provider Name (Legal Business Name): OLUWAFUNMILOLA O SULAIMON NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/05/2020
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14541 DELANO ST
VAN NUYS CA
91411-2820
US

IV. Provider business mailing address

75 WASHINGTON ST
FAIRBURN GA
30213-3626
US

V. Phone/Fax

Practice location:
  • Phone: 916-220-6803
  • Fax:
Mailing address:
  • Phone: 310-971-4760
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN242830
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95019936
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: