=====================================================
General NPI Number Information
=====================================================
NPI Number | 1548016900
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RAMOTALAI ABIMBOLA ORUKWOWU FNP-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/26/2024
-----------------------------------------------------
Last Update Date | 04/26/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 29384 GARY DR
-----------------------------------------------------
City | SANTA CLARITA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91387-4433
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-970-5345
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 29384 GARY DR
-----------------------------------------------------
City | CANYON COUNTRY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91387-4433
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 95029814
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------