Provider Demographics
NPI:1326060286
Name:AJIBOLA, ABAYOMI TOMORI
Entity Type:Individual
Prefix:MR
First Name:ABAYOMI
Middle Name:TOMORI
Last Name:AJIBOLA
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 1:7412 GEORGIA AVE NW
Mailing Address - Street 2:SUITE 3
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20012-1754
Mailing Address - Country:US
Mailing Address - Phone:202-541-9500
Mailing Address - Fax:202-541-9553
Practice Address - Street 1:7412 GEORGIA AVE NW
Practice Address - Street 2:SUITE 3
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20012-1754
Practice Address - Country:US
Practice Address - Phone:202-541-9500
Practice Address - Fax:202-541-9553
Is Sole Proprietor?:No
Enumeration Date:2006-07-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCCON0305163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health