Provider Demographics
NPI:1568455251
Name:WAKAM, IRENE BIH (MD)
Entity Type:Individual
Prefix:
First Name:IRENE
Middle Name:BIH
Last Name:WAKAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3555 LOMA VISTA RD
Mailing Address - Street 2:SUITE 215
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-3161
Mailing Address - Country:US
Mailing Address - Phone:805-652-1515
Mailing Address - Fax:805-652-0445
Practice Address - Street 1:3555 LOMA VISTA RD
Practice Address - Street 2:SUITE 215
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-3161
Practice Address - Country:US
Practice Address - Phone:805-652-1515
Practice Address - Fax:805-652-0445
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC050092207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
5569336OtherMEDICAL PIN
F33215Medicare UPIN
C50092Medicare ID - Type Unspecified