Healthcare Provider Details

I. General information

NPI: 1245596402
Provider Name (Legal Business Name): REMI MUSIBAU AJIBOYE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2012
Last Update Date: 02/05/2025
Certification Date: 02/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20911 EARL ST STE 300
TORRANCE CA
90503-4353
US

IV. Provider business mailing address

20911 EARL ST STE 300
TORRANCE CA
90503-4353
US

V. Phone/Fax

Practice location:
  • Phone: 310-974-4800
  • Fax:
Mailing address:
  • Phone: 310-974-4800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberA130753
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: