Provider Demographics
NPI:1659971414
Name:OBAJUWONLO, OLUWAKEMI TEMITAYO
Entity type:Individual
Prefix:
First Name:OLUWAKEMI
Middle Name:TEMITAYO
Last Name:OBAJUWONLO
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 1:4442 AVERY PARK AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89110-5488
Mailing Address - Country:US
Mailing Address - Phone:702-934-0219
Mailing Address - Fax:
Practice Address - Street 1:990 SIERRA RIDGE ST
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89002-9739
Practice Address - Country:US
Practice Address - Phone:702-934-0219
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-29
Last Update Date:2025-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV818969163WG0000X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health