Healthcare Provider Details

I. General information

NPI: 1962353664
Provider Name (Legal Business Name): AISHA OYETOLA ASHAMU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2026
Last Update Date: 02/07/2026
Certification Date: 02/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 S ARROYO PKWY
PASADENA CA
91105-1930
US

IV. Provider business mailing address

2185 W COLLEGE AVE APT 3026
SAN BERNARDINO CA
92407-7027
US

V. Phone/Fax

Practice location:
  • Phone: 626-578-5742
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: