Provider Demographics
NPI:1366146854
Name:ABATAN, TOLULOPE EUNICE
Entity type:Individual
Prefix:
First Name:TOLULOPE
Middle Name:EUNICE
Last Name:ABATAN
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 1:2075 HASKINS WAY
Mailing Address - Street 2:
Mailing Address - City:PLUMAS LAKE
Mailing Address - State:CA
Mailing Address - Zip Code:95961-8023
Mailing Address - Country:US
Mailing Address - Phone:016-582-9599
Mailing Address - Fax:
Practice Address - Street 1:111 HOOPER ST
Practice Address - Street 2:
Practice Address - City:WHEATLAND
Practice Address - State:CA
Practice Address - Zip Code:95692-9735
Practice Address - Country:US
Practice Address - Phone:916-582-9599
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-28
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician