Provider Demographics
NPI:1740059351
Name:AKINJUGBAGBE, ABIMBOLA LAWAL I
Entity type:Individual
Prefix:
First Name:ABIMBOLA
Middle Name:LAWAL
Last Name:AKINJUGBAGBE
Suffix:I
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 1:11735 S GLEN DR APT 1603
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77099-2568
Mailing Address - Country:US
Mailing Address - Phone:346-490-6021
Mailing Address - Fax:
Practice Address - Street 1:11735 S GLEN DR APT 1603
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77099-2568
Practice Address - Country:US
Practice Address - Phone:346-490-6021
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-22
Last Update Date:2023-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst