Individual provider Active NPI

Bolanle Bolaji Balogun, PMHNP

  • Psychiatric/Mental Health Nurse Practitioner
  • Antioch, CA
National Provider Identifier
1831019900
Registry record updated Jul 20, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
2026036906 Issued in CA
Practice address
4684 Greenrock CT
Antioch, CA 94531-4770
Phone
(925) 658-8420
NPI assigned
Jul 20, 2026
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 20, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 2026036906 CA Primary

Addresses

Primary practice location

4684 Greenrock CT
Antioch, CA 94531-4770

Mailing address

4684 Greenrock CT
Antioch, CA 94531-4770
Phone (925) 658-8420

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

NPI Registry JSON

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

{
    "created_epoch": "1784505600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1784505600000",
    "number": "1831019900",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4684 GREENROCK CT",
            "city": "ANTIOCH",
            "state": "CA",
            "postal_code": "945314770",
            "telephone_number": "925-658-8420"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4684 GREENROCK CT",
            "city": "ANTIOCH",
            "state": "CA",
            "postal_code": "945314770",
            "telephone_number": "925-658-8420"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BALOGUN",
        "first_name": "BOLANLE",
        "middle_name": "BOLAJI",
        "credential": "PMHNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2026-07-20",
        "last_updated": "2026-07-20",
        "certification_date": "2026-07-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "CA",
            "license": "2026036906",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Antioch, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 20, 2026; 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.