Provider Demographics
NPI:1689245961
Name:OBAJUWONLO, OLUGBENGA AKINWALE
Entity Type:Individual
Prefix:
First Name:OLUGBENGA
Middle Name:AKINWALE
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 1:4442 AVERY PARK AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89110-5488
Mailing Address - Country:US
Mailing Address - Phone:702-541-4817
Mailing Address - Fax:
Practice Address - Street 1:4442 AVERY PARK AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89110-5488
Practice Address - Country:US
Practice Address - Phone:702-934-0219
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-07
Last Update Date:2021-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst