Healthcare Provider Details

I. General information

NPI: 1851771067
Provider Name (Legal Business Name): ADEOLA AYODELE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/02/2015
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 BUSINESS CENTER CIR SUITE 105
NEWBURY PARK CA
91320-1144
US

IV. Provider business mailing address

2108 N ST # 6856
SACRAMENTO CA
95816-5712
US

V. Phone/Fax

Practice location:
  • Phone: 323-989-3561
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number31186
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: