Healthcare Provider Details

I. General information

NPI: 1992643753
Provider Name (Legal Business Name): NEUROPSYCHE PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2026
Last Update Date: 03/23/2026
Certification Date: 03/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8605 SANTA MONICA BLVD # 538620
WEST HOLLYWOOD CA
90069-4109
US

IV. Provider business mailing address

8605 SANTA MONICA BLVD # 538620
WEST HOLLYWOOD CA
90069-4109
US

V. Phone/Fax

Practice location:
  • Phone: 909-544-3851
  • Fax: 909-206-0542
Mailing address:
  • Phone: 909-544-3851
  • Fax: 909-206-0542

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: FOLASHADE JAYEOBA-SAMPAY
Title or Position: CEO
Credential: NP
Phone: 909-544-3851