Provider Demographics
NPI:1821405283
Name:ADENIJI, ADEBOWALE (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:ADEBOWALE
Middle Name:
Last Name:ADENIJI
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:WALE
Other - Middle Name:
Other - Last Name:ADENIJI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP
Mailing Address - Street 1:1404 FRANKLIN ST STE 200
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94612-3208
Mailing Address - Country:US
Mailing Address - Phone:415-535-3310
Mailing Address - Fax:510-601-3973
Practice Address - Street 1:1404 FRANKLIN ST STE OAKLAND
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94612-3210
Practice Address - Country:US
Practice Address - Phone:415-535-3310
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-17
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA834153163W00000X
CA95003802363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse