Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | 21514 | SC |
NPI | 1164487955 |
---|---|
Provider Name | Dr. Mojibola Olayinka Solaja |
First Address | Columbia, SC 29223-4300 |
Second Address | Columbia, SC 29223-4300 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/04/2006 |
Last Update Date | 30/10/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
215145 | (05) | SC |
G42174 | (02) | SC |