MEDICARE: ALISIA FAJINMI-BABALOLA

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
1	106H00000X	Marriage & Family Therapist	136853	CA

General Provider Information

NPI Number	:	1386318897
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALISIA FAJINMI-BABALOLA

Provider Business Mailing Address
First Line	:	1522 W 71ST ST
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90047-2036
Country	:	US
Telephone Number	:	424-333-2880
Fax Number	:

Provider Business Practice Location Address
First Line	:	1522 W 71ST ST
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90047-2036
Country	:	US
Telephone Number	:	424-333-2880
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/07/2021
Last Update Date	:	12/07/2025

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