Provider Demographics
NPI:1265820278
Name:OLUKOTUN, OLUWAPELUMI (APRN, CCM)
Entity Type:Individual
Prefix:MS
First Name:OLUWAPELUMI
Middle Name:
Last Name:OLUKOTUN
Suffix:
Gender:F
Credentials:APRN, CCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 558
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS REY
Mailing Address - State:CA
Mailing Address - Zip Code:92068-0558
Mailing Address - Country:US
Mailing Address - Phone:571-400-8461
Mailing Address - Fax:760-692-2750
Practice Address - Street 1:3646 OCEAN RANCH BLVD
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92056-2669
Practice Address - Country:US
Practice Address - Phone:571-400-8461
Practice Address - Fax:760-692-2750
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-27
Last Update Date:2020-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171W00000X, 173000000X, 1744R1102X, 1744R1103X, 174H00000X, 174V00000X, 246Y00000X, 251E00000X, 332100000X, 332B00000X, 347C00000X, 367A00000X, 376G00000X
4217575251B00000X, 171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No171W00000XOther Service ProvidersContractor
No173000000XOther Service ProvidersLegal Medicine
No1744R1102XOther Service ProvidersSpecialistResearch Study
No1744R1103XOther Service ProvidersSpecialistResearch Data Abstracter/Coder
No174H00000XOther Service ProvidersHealth Educator
No174V00000XOther Service ProvidersClinical Ethicist
No246Y00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Health Information
No251B00000XAgenciesCase Management
No251E00000XAgenciesHome Health
No332100000XSuppliersDepartment of Veterans Affairs (VA) Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No347C00000XTransportation ServicesPrivate Vehicle
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No376G00000XNursing Service Related ProvidersNursing Home Administrator