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General NPI Number Information
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NPI Number | 1699599282
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Entity Type | Organization
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Legal Business Name | ILLUME MENTAL HEALTH GROUP
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Dates
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Enumeration Date | 11/11/2024
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Last Update Date | 11/20/2024
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Provider Practice Location Address
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Address Line | 210 S ORANGE GROVE BLVD
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City | PASADENA
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State | CA
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Zip | 91105-1705
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Country | US
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Telephone | 323-300-4673
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Fax |
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Provider Business Mailing Address
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Address Line | 1249 S GRAND AVE APT 615
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City | LOS ANGELES
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State | CA
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Zip | 90015-4556
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Country | US
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Telephone | 704-214-1102
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. ADESEWA ADELEKUN
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Credential | MD
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Telephone | 323-300-4673
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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