Provider Demographics
NPI:1386021509
Name:UNACHUKWU, EMMANUEL OBIAJULU (MD)
Entity Type:Individual
Prefix:
First Name:EMMANUEL
Middle Name:OBIAJULU
Last Name:UNACHUKWU
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 1:425 E FOOTHILL BLVD
Mailing Address - Street 2:
Mailing Address - City:RIALTO
Mailing Address - State:CA
Mailing Address - Zip Code:92376-5153
Mailing Address - Country:US
Mailing Address - Phone:909-546-1050
Mailing Address - Fax:909-546-1061
Practice Address - Street 1:425 E FOOTHILL BLVD
Practice Address - Street 2:
Practice Address - City:RIALTO
Practice Address - State:CA
Practice Address - Zip Code:92376-5153
Practice Address - Country:US
Practice Address - Phone:909-546-1050
Practice Address - Fax:909-546-1061
Is Sole Proprietor?:No
Enumeration Date:2015-04-27
Last Update Date:2017-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA150606208000000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1386021509Medicaid