Provider Demographics
NPI:1295209047
Name:AJIBOYE, ABIBAT BIODUN (NP)
Entity Type:Individual
Prefix:
First Name:ABIBAT
Middle Name:BIODUN
Last Name:AJIBOYE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:ABIBAT
Other - Middle Name:BIODUN
Other - Last Name:AREMU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:3056 CASTRO VALLEY BLVD STE 102
Mailing Address - Street 2:
Mailing Address - City:CASTRO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94546-5510
Mailing Address - Country:US
Mailing Address - Phone:408-766-2104
Mailing Address - Fax:
Practice Address - Street 1:39500 LIBERTY ST
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-2211
Practice Address - Country:US
Practice Address - Phone:510-770-8133
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-15
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95114428163W00000X
CA95028619363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
No163W00000XNursing Service ProvidersRegistered Nurse