Provider Demographics
NPI:1407960792
Name:AYOOLA, ANGELINA IBIWARI (MD)
Entity Type:Individual
Prefix:DR
First Name:ANGELINA
Middle Name:IBIWARI
Last Name:AYOOLA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11706 FALLBROOK DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77065-3510
Mailing Address - Country:US
Mailing Address - Phone:281-955-3377
Mailing Address - Fax:281-807-0457
Practice Address - Street 1:11706 FALLBROOK DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77065-3510
Practice Address - Country:US
Practice Address - Phone:832-912-6282
Practice Address - Fax:281-807-0457
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2021-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK9218207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX7999253OtherAETNA PROVIDER NUMBER
TX0082HDOtherBLUE CROSS BLUE SHEILD
TX0275391-013OtherCIGNA PROVIDER NUMBER
TX00410TMedicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
TX0082HDOtherBLUE CROSS BLUE SHEILD