Healthcare Provider Details

I. General information

NPI: 1831194331
Provider Name (Legal Business Name): AYODEJI ADETAYO AYENI M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2005
Last Update Date: 10/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 MUNZER ST STE C
SHAFTER CA
93263-2042
US

IV. Provider business mailing address

PO BOX 22694
BAKERSFIELD CA
93390-2694
US

V. Phone/Fax

Practice location:
  • Phone: 661-630-5274
  • Fax: 661-630-5290
Mailing address:
  • Phone: 661-364-5244
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA85436
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: