Healthcare Provider Details

I. General information

NPI: 1578446738
Provider Name (Legal Business Name): AYOOLA OLONIMOYO JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2025
Last Update Date: 07/28/2025
Certification Date: 07/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8760 SW 215TH TER
CUTLER BAY FL
33189-7318
US

IV. Provider business mailing address

8760 SW 215TH TER
CUTLER BAY FL
33189-7318
US

V. Phone/Fax

Practice location:
  • Phone: 786-606-0551
  • Fax:
Mailing address:
  • Phone: 786-606-0551
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-25-454707
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: