Provider Demographics
NPI:1225630767
Name:ONYEJIJI, IJEOMA
Entity Type:Individual
Prefix:
First Name:IJEOMA
Middle Name:
Last Name:ONYEJIJI
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 1:511 N HOLLYWOOD WAY
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91505-3406
Mailing Address - Country:US
Mailing Address - Phone:818-841-0710
Mailing Address - Fax:
Practice Address - Street 1:818 E SANDPOINT CT
Practice Address - Street 2:
Practice Address - City:CARSON
Practice Address - State:CA
Practice Address - Zip Code:90746-1527
Practice Address - Country:US
Practice Address - Phone:323-516-5023
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-10
Last Update Date:2021-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1225630767Medicaid