Healthcare Provider Details

I. General information

NPI: 1730479734
Provider Name (Legal Business Name): OLUBUNMI A AJOSE-POPOOLA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2011
Last Update Date: 12/16/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 THE CITY DR S BLDG 56
ORANGE CA
92868-3201
US

IV. Provider business mailing address

101 THE CITY DR S BLDG 56
ORANGE CA
92868-3201
US

V. Phone/Fax

Practice location:
  • Phone: 714-456-5453
  • Fax:
Mailing address:
  • Phone: 714-456-5453
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberFA4020816
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: