Provider Demographics
NPI:1467169235
Name:ANJORIN, OLABIYI WALE
Entity Type:Individual
Prefix:
First Name:OLABIYI
Middle Name:WALE
Last Name:ANJORIN
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 1:2124 PRAIRIE CREEK TRL
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75040-4462
Mailing Address - Country:US
Mailing Address - Phone:469-921-0428
Mailing Address - Fax:
Practice Address - Street 1:2124 PRAIRIE CREEK TRL
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75040-4462
Practice Address - Country:US
Practice Address - Phone:469-921-0428
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-01
Last Update Date:2022-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency