Provider Demographics
NPI:1275391609
Name:FAJANA, OLUSOLA
Entity Type:Individual
Prefix:
First Name:OLUSOLA
Middle Name:
Last Name:FAJANA
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 1:5300 KEMPSRIVER DR # 2025
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23464-5369
Mailing Address - Country:US
Mailing Address - Phone:757-866-2909
Mailing Address - Fax:
Practice Address - Street 1:5300 KEMPSRIVER DR # 2025
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23464-5369
Practice Address - Country:US
Practice Address - Phone:757-866-2909
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-11
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician