Provider Demographics
NPI:1538303300
Name:ALADE-CHESTER, OLUFUNKE FOLASADE (LPT)
Entity Type:Individual
Prefix:MRS
First Name:OLUFUNKE
Middle Name:FOLASADE
Last Name:ALADE-CHESTER
Suffix:
Gender:F
Credentials:LPT
Other - Prefix:MRS
Other - First Name:OLUFUNKE
Other - Middle Name:FOLASADE
Other - Last Name:ALADE-CHESTER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPT
Mailing Address - Street 1:25949 BASE LINE ST APT 108
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92410-7080
Mailing Address - Country:US
Mailing Address - Phone:951-315-0478
Mailing Address - Fax:
Practice Address - Street 1:902 S MYRTLE AVE
Practice Address - Street 2:
Practice Address - City:MONROVIA
Practice Address - State:CA
Practice Address - Zip Code:91016-3427
Practice Address - Country:US
Practice Address - Phone:626-357-3258
Practice Address - Fax:626-301-0868
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-23
Last Update Date:2009-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT34015167G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes167G00000XNursing Service ProvidersLicensed Psychiatric Technician