Provider Demographics
NPI:1891461323
Name:ONIBOKUN, ADESOJI
Entity type:Individual
Prefix:
First Name:ADESOJI
Middle Name:
Last Name:ONIBOKUN
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3836 ANNADALE LN APT 13
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95821-2073
Mailing Address - Country:US
Mailing Address - Phone:510-409-3440
Mailing Address - Fax:
Practice Address - Street 1:1620 SANTA CLARA DR STE 100
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-3559
Practice Address - Country:US
Practice Address - Phone:916-786-3750
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-16
Last Update Date:2025-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No171M00000XOther Service ProvidersCase Manager/Care Coordinator