Provider Demographics
NPI:1891787537
Name:AJILORE, EBENEZER O (MD)
Entity Type:Individual
Prefix:
First Name:EBENEZER
Middle Name:O
Last Name:AJILORE
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:50 ALESSANDRO PL
Mailing Address - Street 2:SUITE 310
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91105-3149
Mailing Address - Country:US
Mailing Address - Phone:626-796-9114
Mailing Address - Fax:626-796-8523
Practice Address - Street 1:50 ALESSANDRO PL
Practice Address - Street 2:SUITE 310
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-3149
Practice Address - Country:US
Practice Address - Phone:626-796-9114
Practice Address - Fax:626-796-8523
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-18
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA30816207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB50151Medicare UPIN