Provider Demographics
NPI:1720761810
Name:HAUGABROOK, ADESOLA
Entity Type:Individual
Prefix:
First Name:ADESOLA
Middle Name:
Last Name:HAUGABROOK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 S MILLIKEN AVE STE E1098
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91761-8112
Mailing Address - Country:US
Mailing Address - Phone:951-880-7624
Mailing Address - Fax:
Practice Address - Street 1:3425 E PARADUXX PRIVADO
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91762-7505
Practice Address - Country:US
Practice Address - Phone:951-880-7624
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-08
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula