Adin Samuel Vaewsorn, RN, PMHNP

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

95018370 Issued in CA

Practice address

1501 Fruitvale Ave
Oakland, CA 94601-2322

Phone

(510) 635-5200

NPI assigned

Aug 3, 2020

Sex

Male

Sole proprietor

No

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

Specialty

Nurse Practitioner

Education

Other, 2021

Medicare assignment

May accept Medicare assignment

Telehealth

Offers telehealth services

Group practices

Bonita House, Inc.Group PAC ID 1153510953, 2 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner, Registered Nurse

State licenses

Practice roles

Locations

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.

• Bonita House, Inc.

  • Case Management Agency
  • Oakland, CA
  • NPI 1073728770
  Medicare reassignment Care Compare group NPD
• La Clinica de la Raza Inc

  • Federally Qualified Health Center (FQHC)
  • Concord, CA
  • NPI 1538181482
  Medicare reassignment
• Bonita House, Inc.

  • Community/Behavioral Health Agency
  • Berkeley, CA
  • NPI 1235344912
  NPD
• Bonita House, Inc.

  • Community/Behavioral Health Agency
  • Oakland, CA
  • NPI 1902253016
  NPD
• La Clinica de la Raza Inc

  • Federally Qualified Health Center (FQHC)
  • Oakland, CA
  • NPI 1144336181
  NPD
• La Clinica de la Raza Inc

  • Federally Qualified Health Center (FQHC)
  • Oakland, CA
  • NPI 1346262292
  NPD

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

{
    "created_epoch": "1596412800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1742342400000",
    "number": "1932719192",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1501 FRUITVALE AVE",
            "city": "OAKLAND",
            "state": "CA",
            "postal_code": "946012322",
            "telephone_number": "510-635-5200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1501 FRUITVALE AVE",
            "city": "OAKLAND",
            "state": "CA",
            "postal_code": "946012322",
            "telephone_number": "510-635-5200"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1605 Jefferson St",
            "address_purpose": "LOCATION",
            "city": "Oakland",
            "state": "CA",
            "postal_code": "946121215",
            "country_code": "US",
            "telephone_number": "510-923-1099",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "VAEWSORN",
        "first_name": "ADIN",
        "middle_name": "SAMUEL",
        "credential": "RN, PMHNP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-08-03",
        "last_updated": "2025-03-19",
        "certification_date": "2025-03-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "CA",
            "license": "95204521",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "CA",
            "license": "95018370",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Leticia Vaca Williams, LCSW
• Eliska Jennifer Vacek
• Domenic Vachini
• Vidhi Vadera, MPT
• Alyssa D Vado
• Arianna Vaewsorn, LCSW
• Paniz Vafaei, M.D.
• Hetvee Mayursinh Vaghela
• Anuj Vaid, MD
• Christina Vaile, LCSW

• Psychiatric/Mental Health Nurse Practitioner in Oakland, CA
• Providers in Oakland, CA by specialty
• Psychiatric/Mental Health Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.