Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363L00000X | Nurse Practitioner | 95003340 | CA |
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 95003340 | CA |
NPI | 1003280892 |
---|---|
Provider Name | John Adeniji |
First Address | Redlands, CA 92373-8054 |
Second Address | Redlands, CA 92373-8054 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/11/2015 |
Last Update Date | 08/10/2021 |