Provider Demographics
NPI:1679723944
Name:SANNI-AWAL, FOLASADE AGNES (RN)
Entity type:Individual
Prefix:
First Name:FOLASADE
Middle Name:AGNES
Last Name:SANNI-AWAL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21151 S WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90501-1724
Mailing Address - Country:US
Mailing Address - Phone:310-527-1751
Mailing Address - Fax:
Practice Address - Street 1:2046 W 92ND ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90047-3501
Practice Address - Country:US
Practice Address - Phone:310-527-1751
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-24
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95029841363LP0808X, 363LP0808X
CA680436163WP0808X, 163WH0200X, 163WH1000X, 163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163WH1000XNursing Service ProvidersRegistered NurseHospice