Provider Demographics
NPI:1851253348
Name:ODUFALU, NICOLE ADEOLA
Entity type:Individual
Prefix:
First Name:NICOLE ADEOLA
Middle Name:
Last Name:ODUFALU
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 1:200 S ZOO LN UNIT 316
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92701-8801
Mailing Address - Country:US
Mailing Address - Phone:951-529-1153
Mailing Address - Fax:
Practice Address - Street 1:200 S ZOO LN UNIT 316
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92701-8801
Practice Address - Country:US
Practice Address - Phone:951-529-1153
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-12-02
Last Update Date:2025-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula