Provider Demographics
NPI:1003517731
Name:FASUGBE, OLUWASEUN KEHINDE (RN)
Entity Type:Individual
Prefix:MR
First Name:OLUWASEUN
Middle Name:KEHINDE
Last Name:FASUGBE
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:OLU
Other - Middle Name:
Other - Last Name:FASUGBE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:35550 BYRON TRL
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:CA
Mailing Address - Zip Code:92223-6217
Mailing Address - Country:US
Mailing Address - Phone:916-805-9443
Mailing Address - Fax:
Practice Address - Street 1:35550 BYRON TRL
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:CA
Practice Address - Zip Code:92223-6217
Practice Address - Country:US
Practice Address - Phone:916-805-9443
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-10
Last Update Date:2023-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9503609163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse