Active NPI
Olatunji Ajibola, PHD
- Psychologist
- San Bernardino, CA
National Provider Identifier
1821044959
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- PSY11659
- Practice address
- 1505 W Highland Ave Ste 16
San Bernardino, CA 92411-1215 - Phone
- (909) 880-0600
- Fax
- (909) 473-1918
- NPI assigned
- May 26, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | PSY11659 | CA | Primary |
Addresses
Primary practice location
1505 W Highland Ave Ste 16
San Bernardino, CA 92411-1215
Mailing address
PO Box 90153
San Bernardino, CA 92427-1153
Phone (909) 880-0600
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY11659 | CA | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1148601600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1270771200000",
"number": "1821044959",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 90153",
"city": "SAN BERNARDINO",
"state": "CA",
"postal_code": "924271153",
"telephone_number": "909-880-0600",
"fax_number": "909-473-1918"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1505 W HIGHLAND AVE STE 16",
"city": "SAN BERNARDINO",
"state": "CA",
"postal_code": "924111215",
"telephone_number": "909-880-0600",
"fax_number": "909-473-1918"
}
],
"practiceLocations": [],
"basic": {
"last_name": "AJIBOLA",
"first_name": "OLATUNJI",
"name_prefix": "Dr.",
"credential": "PHD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-05-26",
"last_updated": "2010-04-09",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "CA",
"license": "PSY11659",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Bernardino, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 9, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.