Provider Demographics
NPI:1093147209
Name:AGBAJE, TOKUNBOH
Entity Type:Individual
Prefix:MR
First Name:TOKUNBOH
Middle Name:
Last Name:AGBAJE
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:PO BOX 11867
Mailing Address - Street 2:CORRECTIONAL HEALTH
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93775-1867
Mailing Address - Country:US
Mailing Address - Phone:559-600-3229
Mailing Address - Fax:559-600-7687
Practice Address - Street 1:1225 M ST
Practice Address - Street 2:CORRECTIONAL HEALTH, 2ND FL
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93721-1805
Practice Address - Country:US
Practice Address - Phone:559-600-9352
Practice Address - Fax:559-442-5277
Is Sole Proprietor?:No
Enumeration Date:2013-07-30
Last Update Date:2013-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA768305163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse