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NPI Code Detail

MEDICARE: PRINCESS AJIBOLA

MEDICARE: PRINCESS AJIBOLA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1172V00000XCommunity Health Worker

General Provider Information

NPI Number : 1104761253
Entity Type Code : Individual
Provider Name (Legal Business Name) : PRINCESS AJIBOLA
Provider Business Mailing Address
First Line : 1080 FURTH RD
Second Line :
City : VALLEY STREAM
State : NY
Zip : 11581-2534
Country : US
Telephone Number : 516-360-7663
Fax Number :
Provider Business Practice Location Address
First Line : 41550 ECLECTIC ST
Second Line :
City : PALM DESERT
State : CA
Zip : 92260-1967
Country : US
Telephone Number : 760-299-5181
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/23/2026
Last Update Date : 04/23/2026

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Directions to “ PRINCESS AJIBOLA ” Practice Location

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