Provider Demographics
NPI:1376266080
Name:AJIJOLA, OLUWATOSIN ADEYINKA
Entity Type:Individual
Prefix:MR
First Name:OLUWATOSIN
Middle Name:ADEYINKA
Last Name:AJIJOLA
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 1:15652 COBALT RD
Mailing Address - Street 2:
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92394-9596
Mailing Address - Country:US
Mailing Address - Phone:909-789-0812
Mailing Address - Fax:916-269-6407
Practice Address - Street 1:15652 COBALT RD
Practice Address - Street 2:
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92394-9596
Practice Address - Country:US
Practice Address - Phone:909-789-0812
Practice Address - Fax:916-269-6407
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-19
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA342000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes342000000XTransportation ServicesTransportation Network Company