Provider Demographics
NPI:1295209047
Name:AJIBOYE, ABIBAT BIODUN (NP)
Entity type:Individual
Prefix:
First Name:ABIBAT
Middle Name:BIODUN
Last Name:AJIBOYE
Suffix:
Gender:
Credentials:NP
Other - Prefix:
Other - First Name:ABIBAT
Other - Middle Name:BIODUN
Other - Last Name:AREMU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:4695 CHABOT DR STE 200
Mailing Address - Street 2:
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94588-2756
Mailing Address - Country:US
Mailing Address - Phone:925-261-7728
Mailing Address - Fax:925-420-8625
Practice Address - Street 1:4695 CHABOT DR STE 200
Practice Address - Street 2:
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94588-2756
Practice Address - Country:US
Practice Address - Phone:925-261-7728
Practice Address - Fax:925-420-8625
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-15
Last Update Date:2025-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
373H00000X
CANP95028619363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
No373H00000XNursing Service Related ProvidersDay Training/Habilitation SpecialistGroup - Single Specialty