Provider Demographics
NPI:1669170528
Name:ADESINA, MAYOWA (DNP, PMHNP)
Entity type:Individual
Prefix:DR
First Name:MAYOWA
Middle Name:
Last Name:ADESINA
Suffix:
Gender:M
Credentials:DNP, PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24613 HUDSON ST
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92551-6973
Mailing Address - Country:US
Mailing Address - Phone:909-327-8360
Mailing Address - Fax:
Practice Address - Street 1:24613 HUDSON ST
Practice Address - Street 2:
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92551-6973
Practice Address - Country:US
Practice Address - Phone:909-327-8360
Practice Address - Fax:909-247-3328
Is Sole Proprietor?:No
Enumeration Date:2023-02-21
Last Update Date:2024-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95024352363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA95024352OtherNP LICENSE NUMBER & NP FURNISHING