Provider Demographics
NPI:1467485730
Name:AJAKWE, REGINALD CHINAEDU (MD)
Entity Type:Individual
Prefix:DR
First Name:REGINALD
Middle Name:CHINAEDU
Last Name:AJAKWE
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:PO BOX 893520
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92589
Mailing Address - Country:US
Mailing Address - Phone:818-325-2088
Mailing Address - Fax:818-563-6201
Practice Address - Street 1:201 S BUENA VISTA ST STE 238
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91505-4576
Practice Address - Country:US
Practice Address - Phone:818-325-2088
Practice Address - Fax:818-563-6201
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-09
Last Update Date:2017-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA93702207LP2900X, 208VP0014X
CAA98702207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWA93702AMedicare PIN
CAI62331Medicare UPIN