Adebukola Elizabeth Olusanya, NURSE PRACTITIONER

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

95017582 Issued in CA

Practice address

2940 Inland Empire Blvd
Ontario, CA 91764-4898

Phone

(909) 458-1350

Fax

(909) 579-8149

NPI assigned

Jan 23, 2019

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

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

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: adebukola.olusanya.p1@direct.cvma.nextgenshare.com

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.

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  Medicare reassignment NPD
• Signify Health Medical Associates of California, PC

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  Medicare reassignment NPD
• Zenmedicine

  • General Practice Physician
  • West Covina, CA
  • NPI 1821567488

  Single Specialty

  Medicare reassignment NPD

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

{
    "created_epoch": "1548201600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1759104000000",
    "number": "1710441720",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17965 CRABAPPLE CT",
            "city": "SAN BERNARDINO",
            "state": "CA",
            "postal_code": "924070554",
            "telephone_number": "909-244-4313"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2940 INLAND EMPIRE BLVD",
            "city": "ONTARIO",
            "state": "CA",
            "postal_code": "917644898",
            "telephone_number": "909-458-1350",
            "fax_number": "909-579-8149"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "17965 crabapple court San Bernardino",
            "address_purpose": "LOCATION",
            "city": "San Bernardino",
            "state": "CA",
            "postal_code": "92407",
            "country_code": "US",
            "telephone_number": "909-244-4313",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "OLUSANYA",
        "first_name": "ADEBUKOLA",
        "middle_name": "ELIZABETH",
        "credential": "NURSE PRACTITIONER",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-01-23",
        "last_updated": "2025-09-29",
        "certification_date": "2025-09-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "95017582",
            "primary": true
        },
        {
            "code": "163WP0808X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Psychiatric/Mental Health",
            "state": "CA",
            "license": "749486",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jennifer Haley Olivares, BCBA
• Corina Joyce Olivera, MSW
• Destiny Olmedo
• Briana Olmos
• Michelle Olmos
• Rachel Olvera
• One Care Hospice of California, LLC
• Ontario del Sol Adhc, LLC
• Ontario Dental Center
• Ontario Dialysis Center LLC

• Family Nurse Practitioner in Ontario, CA
• Providers in Ontario, CA by specialty
• Family Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.