Provider Demographics
NPI:1588439822
Name:AFONJA, ADEREMI O
Entity type:Individual
Prefix:MR
First Name:ADEREMI
Middle Name:O
Last Name:AFONJA
Suffix:
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 1:107 RANCH ROAD 620 S STE 111AB
Mailing Address - Street 2:
Mailing Address - City:LAKEWAY
Mailing Address - State:TX
Mailing Address - Zip Code:78734-3942
Mailing Address - Country:US
Mailing Address - Phone:512-361-7935
Mailing Address - Fax:
Practice Address - Street 1:107 RANCH ROAD 620 S STE 111AB
Practice Address - Street 2:
Practice Address - City:LAKEWAY
Practice Address - State:TX
Practice Address - Zip Code:78734-3942
Practice Address - Country:US
Practice Address - Phone:512-361-7935
Practice Address - Fax:512-244-0021
Is Sole Proprietor?:No
Enumeration Date:2023-11-16
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246QL0900XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyLaboratory Management