Provider Demographics
NPI:1538748520
Name:OLADE, FEHINTOLU GBEMISOLA (NP)
Entity type:Individual
Prefix:
First Name:FEHINTOLU
Middle Name:GBEMISOLA
Last Name:OLADE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:FEHINTOLU
Other - Middle Name:GBEMISOLA
Other - Last Name:BADA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP
Mailing Address - Street 1:43923 SPRING ST
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93536-2453
Mailing Address - Country:US
Mailing Address - Phone:818-744-7239
Mailing Address - Fax:
Practice Address - Street 1:1601 W AVENUE J
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-2824
Practice Address - Country:US
Practice Address - Phone:661-945-2716
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-06
Last Update Date:2021-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95017080363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty