Provider Demographics
NPI:1073898490
Name:OLUSEYI-OKE, JOHN IDOWU (LPT)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:IDOWU
Last Name:OLUSEYI-OKE
Suffix:
Gender:M
Credentials:LPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 FOXPARK DRIVE
Mailing Address - Street 2:
Mailing Address - City:CLAREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:91711
Mailing Address - Country:US
Mailing Address - Phone:909-267-4522
Mailing Address - Fax:
Practice Address - Street 1:610 FOXPARK DR
Practice Address - Street 2:
Practice Address - City:CLAREMONT
Practice Address - State:CA
Practice Address - Zip Code:91711-3632
Practice Address - Country:US
Practice Address - Phone:909-267-4522
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-17
Last Update Date:2011-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 31572167G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes167G00000XNursing Service ProvidersLicensed Psychiatric Technician