Provider Demographics
NPI:1619164852
Name:AJALA, YOLANDA BOLANLE (MD)
Entity Type:Individual
Prefix:
First Name:YOLANDA
Middle Name:BOLANLE
Last Name:AJALA
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 1:7015 ALMEDA RD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77054-2101
Mailing Address - Country:US
Mailing Address - Phone:832-409-1677
Mailing Address - Fax:281-476-7032
Practice Address - Street 1:8619 BROADWAY ST
Practice Address - Street 2:SUITE 101
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584-8782
Practice Address - Country:US
Practice Address - Phone:832-409-1677
Practice Address - Fax:832-409-1697
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-02
Last Update Date:2016-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM7004207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXM7004OtherTSMBE
TX8K1300Medicare PIN