Provider Demographics
NPI:1134124001
Name:NDULUE, CHUKWUEMEKA (MD)
Entity Type:Individual
Prefix:
First Name:CHUKWUEMEKA
Middle Name:
Last Name:NDULUE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 SPRUCE ST
Mailing Address - Street 2:
Mailing Address - City:GRIDLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95948-2239
Mailing Address - Country:US
Mailing Address - Phone:530-846-1400
Mailing Address - Fax:530-846-4762
Practice Address - Street 1:135 SPRUCE ST
Practice Address - Street 2:
Practice Address - City:GRIDLEY
Practice Address - State:CA
Practice Address - Zip Code:95948-2239
Practice Address - Country:US
Practice Address - Phone:530-846-1400
Practice Address - Fax:530-846-4762
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-16
Last Update Date:2013-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA48878208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARHM53931FMedicaid
CA553928Medicare Oscar/Certification
CARHM53931FMedicaid
553931Medicare Oscar/Certification
CA00A488780Medicare PIN