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General NPI Number Information
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NPI Number | 1114686029
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Entity Type | Individual
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Provider Name | GBOLAHAN IDRIS OSHIKOYA LVN
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Gender | Male
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Dates
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Enumeration Date | 12/08/2021
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Last Update Date | 07/17/2025
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Provider Practice Location Address
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Address Line | 2620 26TH AVE
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City | OAKLAND
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State | CA
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Zip | 94601-1907
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Country | US
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Telephone | 510-437-2363
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Fax |
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Provider Business Mailing Address
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Address Line | 240 EDMONDS RD BLDG D
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City | REDWOOD CITY
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State | CA
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Zip | 94062-3813
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Country | US
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Telephone | 650-209-1100
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 164X00000X
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Taxonomy Name | Licensed Vocational Nurse
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License Number | 689592
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License Number State | CA
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