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NPI Code Detail

MEDICARE: AJETSRIA HEALTH

MEDICARE: AJETSRIA HEALTH
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TC0700XClinical Psychologist

General Provider Information

NPI Number : 1588527204
Entity Type Code : Organization
Provider Name (Legal Business Name) : AJETSRIA HEALTH
Provider Business Mailing Address
First Line : 18 N 12TH ST UNIT 3668
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55403-1311
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 18 N 12TH ST UNIT 3668
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55403-1311
Country : US
Telephone Number : 612-425-1086
Fax Number :
Authorized Official
Title or Position : OWNER/PSYCHOLOGIST
Name : DR. RACHAEL ITUNU AJETOMOBI
Credential : LP
Telephone Number : 507-339-5083
Provider Enumeration Date : 12/09/2025
Last Update Date : 04/16/2026

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