Provider Demographics
NPI:1083488845
Name:AKINSOLA, AYOBAMI
Entity Type:Individual
Prefix:
First Name:AYOBAMI
Middle Name:
Last Name:AKINSOLA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17906 LETO WAY
Mailing Address - Street 2:
Mailing Address - City:LATHROP
Mailing Address - State:CA
Mailing Address - Zip Code:95330-8235
Mailing Address - Country:US
Mailing Address - Phone:323-335-9346
Mailing Address - Fax:
Practice Address - Street 1:17906 LETO WAY
Practice Address - Street 2:
Practice Address - City:LATHROP
Practice Address - State:CA
Practice Address - Zip Code:95330-8235
Practice Address - Country:US
Practice Address - Phone:323-335-9346
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-13
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician