Individual provider · NPI-1

Grace O Adeagbo

Nurse Practitioner, Psych/Mental Health · Torrance, CA

NPI number1992986731
StatusActive
Last updated in NPPESJun 25, 2021

Details

NPI
1992986731
Entity type
Individual (NPI-1)
Name
Grace O Adeagbo
Sex
Female
Sole proprietor
No
Enumeration date
Nov 20, 2007
Certification date
Jun 25, 2021
Last updated
Jun 25, 2021

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
363LP0808X Nurse Practitioner, Psych/Mental Health95005218CAYes
163W00000X Registered Nurse635727CA
163WH0200X Registered Nurse, Home Health635727CA
363LF0000X Nurse Practitioner, Family95005218CA

Practice location

2204 Torrance Blvd Ste 102
Torrance, CA 90501-0502

Phone 424-488-2030 · Fax 424-488-2202

Mailing address

9628 Adoree St
Downey, CA 90242-4900

Phone 562-803-7800

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