Provider Demographics
NPI:1265015069
Name:MOBAYO, OLABANJO J
Entity Type:Individual
Prefix:
First Name:OLABANJO
Middle Name:J
Last Name:MOBAYO
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 1:108 GUAYMAS DR
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34743-9224
Mailing Address - Country:US
Mailing Address - Phone:770-256-4384
Mailing Address - Fax:
Practice Address - Street 1:108 GUAYMAS DR
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34743-9224
Practice Address - Country:US
Practice Address - Phone:770-256-4384
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-30
Last Update Date:2021-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
No347C00000XTransportation ServicesPrivate Vehicle