Provider Demographics
NPI:1205167434
Name:MAKINDE-AGU, OBIANUJU L (FNP)
Entity type:Individual
Prefix:MRS
First Name:OBIANUJU
Middle Name:L
Last Name:MAKINDE-AGU
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MS
Other - First Name:OBIANUJU
Other - Middle Name:
Other - Last Name:AGU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1691 THE ALAMEDA
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95126-2203
Mailing Address - Country:US
Mailing Address - Phone:408-795-3619
Mailing Address - Fax:408-287-0405
Practice Address - Street 1:2535 16TH ST
Practice Address - Street 2:STE 100
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93301-3417
Practice Address - Country:US
Practice Address - Phone:661-334-4400
Practice Address - Fax:661-634-1040
Is Sole Proprietor?:No
Enumeration Date:2010-01-28
Last Update Date:2024-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18069363LP0808X
CANP18069363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health