Individual
AYOBAMI NOHEEM AGORO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CEO
Contact information
Practice address
12362 W JOBLANCA RD, AVONDALE, AZ 85323-3130
(202) 290-7492
Mailing address
12362 W JOBLANCA RD, AVONDALE, AZ 85323-3130
(202) 290-7492
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00
N/A
—
Enumeration date
10/13/2020
Last updated
10/13/2020
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