Provider Demographics
NPI:1760969562
Name:ADENIJI, CHRYSTANYA A (DNP, PMHNP-BC)
Entity Type:Individual
Prefix:DR
First Name:CHRYSTANYA
Middle Name:A
Last Name:ADENIJI
Suffix:
Gender:F
Credentials:DNP, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1368 OAK ST
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92373-6868
Mailing Address - Country:US
Mailing Address - Phone:916-844-4214
Mailing Address - Fax:
Practice Address - Street 1:514 N CALIFORNIA AVE STE 18
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:CA
Practice Address - Zip Code:92223-2120
Practice Address - Country:US
Practice Address - Phone:951-769-7733
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-24
Last Update Date:2019-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95009539363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA95009539OtherNURSE PRACTITIONER LICENSE/FURNISHING