Provider Demographics
NPI:1427558949
Name:IGBINOSUN, FOLLEY FELIX (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:FOLLEY
Middle Name:FELIX
Last Name:IGBINOSUN
Suffix:
Gender:M
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1521 CUMBERLAND CT
Mailing Address - Street 2:
Mailing Address - City:PERRIS
Mailing Address - State:CA
Mailing Address - Zip Code:92571-3723
Mailing Address - Country:US
Mailing Address - Phone:909-362-9321
Mailing Address - Fax:
Practice Address - Street 1:12364 PERRIS BLVD
Practice Address - Street 2:
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92557-7423
Practice Address - Country:US
Practice Address - Phone:951-243-8871
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-21
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95008632363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner