1578042214 NPI number — MR. IFEOLUWA JONATHAN ADERINTO FNP-C

Table of content: MR. IFEOLUWA JONATHAN ADERINTO FNP-C (NPI 1578042214)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578042214 NPI number — MR. IFEOLUWA JONATHAN ADERINTO FNP-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ADERINTO
Provider First Name:
IFEOLUWA
Provider Middle Name:
JONATHAN
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
FNP-C
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1578042214
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/05/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14803 VANOWEN ST APT 13
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VAN NUYS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91405-3868
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
714-606-3661
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
201 S BUENA VISTA ST STE 238
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BURBANK
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91505-4576
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-325-2088
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/13/2018

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  95009633 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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