Provider Demographics
NPI:1518659143
Name:ADENIYI, TOLULOPE ADETOLA
Entity Type:Individual
Prefix:
First Name:TOLULOPE
Middle Name:ADETOLA
Last Name:ADENIYI
Suffix:
Gender:F
Credentials:
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 99
Mailing Address - Street 2:
Mailing Address - City:ARMONA
Mailing Address - State:CA
Mailing Address - Zip Code:93202-0099
Mailing Address - Country:US
Mailing Address - Phone:619-431-6393
Mailing Address - Fax:
Practice Address - Street 1:13750 LARKSPUR WAY
Practice Address - Street 2:
Practice Address - City:ARMONA
Practice Address - State:CA
Practice Address - Zip Code:93202-0099
Practice Address - Country:US
Practice Address - Phone:619-431-6393
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-23
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95214120163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse