Provider Demographics
NPI:1477149243
Name:OJO, TEMITAYO
Entity Type:Individual
Prefix:
First Name:TEMITAYO
Middle Name:
Last Name:OJO
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 1:215 W AMBER WAY
Mailing Address - Street 2:
Mailing Address - City:HANFORD
Mailing Address - State:CA
Mailing Address - Zip Code:93230-1752
Mailing Address - Country:US
Mailing Address - Phone:404-637-3975
Mailing Address - Fax:
Practice Address - Street 1:215 W AMBER WAY
Practice Address - Street 2:
Practice Address - City:HANFORD
Practice Address - State:CA
Practice Address - Zip Code:93230-1752
Practice Address - Country:US
Practice Address - Phone:404-637-3975
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-16
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95132895163W00000X
CA95023765363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse