Healthcare Provider Details

I. General information

NPI: 1871798207
Provider Name (Legal Business Name): MICHAEL AJAO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2007
Last Update Date: 10/16/2025
Certification Date: 10/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34800 BOB WILSON DR NMCSD
SAN DIEGO CA
92134-1098
US

IV. Provider business mailing address

7544 CHARMANT DR APT 1326
SAN DIEGO CA
92122-5045
US

V. Phone/Fax

Practice location:
  • Phone: 619-532-7579
  • Fax:
Mailing address:
  • Phone: 858-307-4656
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number0101244668
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code2083A0100X
TaxonomyAerospace Medicine Physician
License Number0101244668
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: