Healthcare Provider Details

I. General information

NPI: 1841964087
Provider Name (Legal Business Name): ADETOUN ADENIKE OBADOFIN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2021
Last Update Date: 06/25/2024
Certification Date: 06/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 N WIGET LN
WALNUT CREEK CA
94598-2408
US

IV. Provider business mailing address

450 N WIGET LN
WALNUT CREEK CA
94598-2408
US

V. Phone/Fax

Practice location:
  • Phone: 925-691-9806
  • Fax:
Mailing address:
  • Phone: 925-691-9806
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95017784
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: