Provider Demographics
NPI:1831194331
Name:AYENI, AYODEJI ADETAYO (MD)
Entity type:Individual
Prefix:
First Name:AYODEJI
Middle Name:ADETAYO
Last Name:AYENI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 22694
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93390-2694
Mailing Address - Country:US
Mailing Address - Phone:661-364-5244
Mailing Address - Fax:
Practice Address - Street 1:501 MUNZER ST STE C
Practice Address - Street 2:
Practice Address - City:SHAFTER
Practice Address - State:CA
Practice Address - Zip Code:93263-2042
Practice Address - Country:US
Practice Address - Phone:661-630-5274
Practice Address - Fax:661-630-5290
Is Sole Proprietor?:No
Enumeration Date:2005-06-20
Last Update Date:2016-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA85436208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics