Provider Demographics
NPI:1083953202
Name:IGBINOSA, IREKPITAN EHIGHALUA
Entity Type:Individual
Prefix:MRS
First Name:IREKPITAN
Middle Name:EHIGHALUA
Last Name:IGBINOSA
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 1:12125 DAY ST
Mailing Address - Street 2:E315
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92557-6702
Mailing Address - Country:US
Mailing Address - Phone:951-683-0633
Mailing Address - Fax:951-684-6489
Practice Address - Street 1:12125 DAY ST
Practice Address - Street 2:E315
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92557-6702
Practice Address - Country:US
Practice Address - Phone:951-683-0633
Practice Address - Fax:951-684-6489
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-07
Last Update Date:2013-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator