Healthcare Provider Details

I. General information

NPI: 1811518152
Provider Name (Legal Business Name): ASTIAN AYOOLA DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/28/2020
Last Update Date: 09/18/2025
Certification Date: 09/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11401 BLOOMFIELD AVE
NORWALK CA
90650-2015
US

IV. Provider business mailing address

3201 SAWTELLE BLVD APT 219
LOS ANGELES CA
90066-1643
US

V. Phone/Fax

Practice location:
  • Phone: 562-863-7011
  • Fax:
Mailing address:
  • Phone: 937-272-4646
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number20A22789
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberOS22792
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: