Provider Demographics
NPI:1629962063
Name:HOPE HAVEN MEDICAL LLC
Entity type:Organization
Organization Name:HOPE HAVEN MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:OLUWAKEMI
Authorized Official - Middle Name:TEMITAYO
Authorized Official - Last Name:OBAJUWONLO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-934-0219
Mailing Address - Street 1:990 SIERRA RIDGE ST
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89002-9739
Mailing Address - Country:US
Mailing Address - Phone:702-934-0219
Mailing Address - Fax:
Practice Address - Street 1:990 SIERRA RIDGE ST
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89002-9739
Practice Address - Country:US
Practice Address - Phone:702-934-0219
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-09
Last Update Date:2025-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty