Healthcare Provider Details

I. General information

NPI: 1588093736
Provider Name (Legal Business Name): AYODELE AJAYI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2013
Last Update Date: 05/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5146 N 11TH AVE APT D208
PHOENIX AZ
85013-2161
US

IV. Provider business mailing address

5146 N 11TH AVE APT D208
PHOENIX AZ
85013-2265
US

V. Phone/Fax

Practice location:
  • Phone: 240-374-2584
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2279G1100X
TaxonomyGeneral Care Registered Respiratory Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: