Doctor Name: | DR. MOYOSADE ADEYINKA AJALA |
NPI Number: | 1346435815 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MD |
License Number: | BP10027990 |
Business Practice Address: | 410 E Pioneer Pkwy Suite 300 Grand Prairie, TX - 750514983 |
Business Phone Number: | 4697331890 |
Business Fax Number: | 4697331894 |
Mailing Address: | 300 E John Carpenter Fwy, Suite 850 IRVING |
State: | TX |
Postal Code: | 750622727 |
Phone Number: | 9729573000 |
Fax Number: | 9729573005 |
NPI Enumeration Date: | 09/07/2007 |
NPI Last Update Date: | 09/09/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 390200000X |
License Number: | BP10027990 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | TX |
Taxonomy Type: | Student, Health Care |
Taxonomy Classification: | Student in an Organized Health Care Education/Training Program |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |