Healthcare Provider Details

I. General information

NPI: 1194680561
Provider Name (Legal Business Name): MRS. RANDALL ME'CHELE AJIBOYE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/18/2025
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 POINTE DR STE 305
BREA CA
92821-7604
US

IV. Provider business mailing address

2555 SPROUT LN UNIT 103
CORONA CA
92883-3665
US

V. Phone/Fax

Practice location:
  • Phone: 562-551-8245
  • Fax:
Mailing address:
  • Phone: 310-722-0442
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: