Provider Demographics
NPI:1083980247
Name:AKANDE, ADERONKE (NP)
Entity Type:Individual
Prefix:
First Name:ADERONKE
Middle Name:
Last Name:AKANDE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35787 BUTCHART ST
Mailing Address - Street 2:
Mailing Address - City:WILDOMAR
Mailing Address - State:CA
Mailing Address - Zip Code:92595-7636
Mailing Address - Country:US
Mailing Address - Phone:951-696-7396
Mailing Address - Fax:
Practice Address - Street 1:3634 ELIZABETH ST
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-2506
Practice Address - Country:US
Practice Address - Phone:951-341-8935
Practice Address - Fax:951-341-8932
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-31
Last Update Date:2017-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21597363LP2300X, 363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily