Provider Demographics
NPI:1518124718
Name:IRIELE, CLIFFORD IFEANYI (MD)
Entity Type:Individual
Prefix:DR
First Name:CLIFFORD
Middle Name:IFEANYI
Last Name:IRIELE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 34819
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90034-0819
Mailing Address - Country:US
Mailing Address - Phone:213-483-0246
Mailing Address - Fax:213-483-0249
Practice Address - Street 1:1711 W TEMPLE ST
Practice Address - Street 2:6642
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90026-5421
Practice Address - Country:US
Practice Address - Phone:213-483-0246
Practice Address - Fax:213-483-0249
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-16
Last Update Date:2011-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1021302084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABZ613AMedicare PIN