Bolaji Gabriel Babatunde, DHA, CPHQ

Primary specialty

Registered NurseTaxonomy code 163W00000X

License

649828 Issued in CA

Practice address

9612 E. Foothilll Blvd Unit 110
Rancho Cucamonga, CA 91730-3547

Phone

(909) 231-0098

NPI assigned

Jul 23, 2021

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1626998400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1626998400000",
    "number": "1164095329",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9612 E. FOOTHILLL BLVD UNIT 110",
            "city": "RANCHO CUCAMONGA",
            "state": "CA",
            "postal_code": "917303547",
            "telephone_number": "909-231-0098"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9612 E. FOOTHILLL BLVD UNIT 110",
            "city": "RANCHO CUCAMONGA",
            "state": "CA",
            "postal_code": "917303547",
            "telephone_number": "909-231-0098"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BABATUNDE",
        "first_name": "BOLAJI",
        "middle_name": "GABRIEL",
        "name_prefix": "Dr.",
        "credential": "DHA, CPHQ",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-07-23",
        "last_updated": "2021-07-23",
        "certification_date": "2021-06-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WA2000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Administrator",
            "state": "CA",
            "license": "RN648928",
            "primary": false
        },
        {
            "code": "163WH1000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Hospice",
            "state": "CA",
            "license": "RN648928",
            "primary": false
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "CA",
            "license": "649828",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Registered Nurse in Rancho Cucamonga, CA
• Providers in Rancho Cucamonga, CA by specialty
• Registered Nurse in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.