Provider Demographics
NPI:1639733405
Name:FALOMO, MOBOLAJI (AUD)
Entity type:Individual
Prefix:
First Name:MOBOLAJI
Middle Name:
Last Name:FALOMO
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:351 DALEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21060-7683
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1320 OLD CHAIN BRIDGE RD STE 185
Practice Address - Street 2:
Practice Address - City:MC LEAN
Practice Address - State:VA
Practice Address - Zip Code:22101-3945
Practice Address - Country:US
Practice Address - Phone:703-942-8110
Practice Address - Fax:703-942-8042
Is Sole Proprietor?:No
Enumeration Date:2019-04-27
Last Update Date:2025-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01455231H00000X, 231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist