=====================================================
General NPI Number Information
=====================================================
NPI Number | 1972447993
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BOLAJI OBASUYI
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/18/2026
-----------------------------------------------------
Last Update Date | 04/18/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1391 MARCELINE DR
-----------------------------------------------------
City | MANTECA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95336-8817
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 209-609-1382
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1391 MARCELINE DR
-----------------------------------------------------
City | MANTECA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95336-8817
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 209-609-1382
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163W00000X
-----------------------------------------------------
Taxonomy Name | Registered Nurse
-----------------------------------------------------
License Number | 95409925
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------