Provider Demographics
NPI:1760542476
Name:AJALA, OLUGBENGA OLATUNJI
Entity Type:Individual
Prefix:MR
First Name:OLUGBENGA
Middle Name:OLATUNJI
Last Name:AJALA
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 1:2023 MACKENZE WAY
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77489-3177
Mailing Address - Country:US
Mailing Address - Phone:832-455-9359
Mailing Address - Fax:
Practice Address - Street 1:2023 MACKENZE WAY
Practice Address - Street 2:
Practice Address - City:MISSOURI CITY
Practice Address - State:TX
Practice Address - Zip Code:77489-3177
Practice Address - Country:US
Practice Address - Phone:832-455-9359
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health