Provider Demographics
NPI:1578308847
Name:AFOLABI, AYISAT
Entity type:Individual
Prefix:
First Name:AYISAT
Middle Name:
Last Name:AFOLABI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19821 LANARK ST
Mailing Address - Street 2:
Mailing Address - City:WINNETKA
Mailing Address - State:CA
Mailing Address - Zip Code:91306-1920
Mailing Address - Country:US
Mailing Address - Phone:818-943-5737
Mailing Address - Fax:
Practice Address - Street 1:1672 W AVENUE J STE 202
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-2861
Practice Address - Country:US
Practice Address - Phone:661-214-3044
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-28
Last Update Date:2024-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical