Provider Demographics
NPI:1053053967
Name:AGUNBIADE, ASHLEY TEMITOPE
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:TEMITOPE
Last Name:AGUNBIADE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3767 CLARINGTON AVE APT 341
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90034-5844
Mailing Address - Country:US
Mailing Address - Phone:213-245-0403
Mailing Address - Fax:
Practice Address - Street 1:5619 N. FIGUEROA ST.
Practice Address - Street 2:
Practice Address - City:LOS ANGELES,
Practice Address - State:CA
Practice Address - Zip Code:90042
Practice Address - Country:US
Practice Address - Phone:818-275-4426
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-11
Last Update Date:2022-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional