Individual provider Active NPI

Adijat Omobolanle Ligali

  • Psychiatric/Mental Health Nurse Practitioner
  • San Diego, CA
National Provider Identifier
1124782115
Registry record updated Nov 12, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
95025305 Issued in CA
Practice address
1111 6TH Ave Ste 204
San Diego, CA 92101-5214
Phone
(415) 671-2165
NPI assigned
Oct 26, 2021
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 12, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 95025305 CA Primary
Registered Nurse 163W00000X 95186824 CA

Addresses

Primary practice location

1111 6TH Ave Ste 204
San Diego, CA 92101-5214

Mailing address

2350 Buhne St
Eureka, CA 95501-3238
Phone (707) 443-4593

Other practice location 1

2350 Buhne St
Eureka, CA 95501-3238
Phone (707) 443-4593

Other practice location 2

25000 Avenue Stanford Ste 167
Valencia, CA 91355-4596
Phone (818) 600-2034

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250224003540 CA Practitioner - Nurse Practitioner 9739609546 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
95186824CAMDRegistered Nurse
95025305CAMDPsychiatric/Mental Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Grow Healthcare Group PC Psychiatric/Mental Health CurrentSince Jan 21, 2025 Accepting new patients
New U Therapy Center & Family Services Inc. Psychiatric/Mental Health PastSince Apr 1, 2025 Accepting new patients

Locations

99 Almaden Blvd
Ste 600
San Jose, CA 95113
Phone (408) 402-4385

66 W Flagler St
Ste 900
Miami, FL 33130
Phone (786) 244-7711

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1635206400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1762905600000",
    "number": "1124782115",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2350 BUHNE ST",
            "city": "EUREKA",
            "state": "CA",
            "postal_code": "955013238",
            "telephone_number": "707-443-4593"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1111 6TH AVE STE 204",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921015214",
            "telephone_number": "415-671-2165"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2350 Buhne St",
            "address_purpose": "LOCATION",
            "city": "Eureka",
            "state": "CA",
            "postal_code": "955013238",
            "country_code": "US",
            "telephone_number": "707-443-4593",
            "fax_number": "707-269-7116",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "25000 Avenue Stanford Ste 167",
            "address_purpose": "LOCATION",
            "city": "Valencia",
            "state": "CA",
            "postal_code": "913554596",
            "country_code": "US",
            "telephone_number": "818-600-2034",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LIGALI",
        "first_name": "ADIJAT",
        "middle_name": "OMOBOLANLE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-10-26",
        "last_updated": "2025-11-12",
        "certification_date": "2025-11-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "CA",
            "license": "95025305",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "CA",
            "license": "95186824",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Diego, CA

Sources for this page

Verify at the official NPI Registry.