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General NPI Number Information
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NPI Number | 1336770312
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Entity Type | Individual
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Provider Name | MORAYO OLATUNBOSUN NP
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Gender | Female
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Dates
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Enumeration Date | 01/29/2020
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Last Update Date | 01/29/2020
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Provider Practice Location Address
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Address Line | 150 MUIR RD
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City | MARTINEZ
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State | CA
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Zip | 94553-4668
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Country | US
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Telephone | 215-667-5632
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Fax |
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Provider Business Mailing Address
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Address Line | 250 BUNCH GRASS TER
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City | FREMONT
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State | CA
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Zip | 94539-8409
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Country | US
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Telephone | 215-667-5632
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | AP140871
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License Number State | TX
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