Provider Demographics
NPI:1609628262
Name:OBAJUWONLO, FELIX O
Entity Type:Individual
Prefix:
First Name:FELIX
Middle Name:O
Last Name:OBAJUWONLO
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 1:5818 CINNABAR AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89110-1791
Mailing Address - Country:US
Mailing Address - Phone:702-591-3112
Mailing Address - Fax:
Practice Address - Street 1:5818 CINNABAR AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89110-1791
Practice Address - Country:US
Practice Address - Phone:702-591-3112
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-04
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker