Healthcare Provider Details

I. General information

NPI: 1376331678
Provider Name (Legal Business Name): OPEMIPO AUDREY AYOLOLA MD, MBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2025
Last Update Date: 05/09/2026
Certification Date: 05/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 PASTEUR DRIVE, ROOM H3580 MC 5640
STANFORD CA
94305
US

IV. Provider business mailing address

300 PASTEUR DRIVE, ROOM H3580 MC 5640
STANFORD CA
94305
US

V. Phone/Fax

Practice location:
  • Phone: 650-723-6412
  • Fax:
Mailing address:
  • Phone: 650-723-6412
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: