Provider Demographics
NPI:1194926469
Name:OBIDI, OLUBUKOLA AJAYI (NP)
Entity type:Individual
Prefix:
First Name:OLUBUKOLA
Middle Name:AJAYI
Last Name:OBIDI
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:OLUBUKOLA
Other - Middle Name:BOYEWA
Other - Last Name:AJAYI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1927 PADILLA DR
Mailing Address - Street 2:
Mailing Address - City:COLTON
Mailing Address - State:CA
Mailing Address - Zip Code:92324-6611
Mailing Address - Country:US
Mailing Address - Phone:305-926-9716
Mailing Address - Fax:
Practice Address - Street 1:1075 CAMINO DEL RIO S
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-3538
Practice Address - Country:US
Practice Address - Phone:619-881-4500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-31
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 9257610363LW0102X
CARN 673401 NP 16839363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health