Provider Demographics
NPI:1407494735
Name:ADEGBITE, ADEKUNLE SAMSON (NP)
Entity Type:Individual
Prefix:
First Name:ADEKUNLE
Middle Name:SAMSON
Last Name:ADEGBITE
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:231 E ALESSANDRO BLVD # A805
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92508-5084
Mailing Address - Country:US
Mailing Address - Phone:951-341-8935
Mailing Address - Fax:951-341-8932
Practice Address - Street 1:4960 ARLINGTON AVE STE B
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92504-2738
Practice Address - Country:US
Practice Address - Phone:951-341-8930
Practice Address - Fax:951-341-8932
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-17
Last Update Date:2020-02-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CANP95013014363L00000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CANP95013014OtherSTATE OF CALIFORNIA BOARD OF REGISTERED NURSING