Provider Demographics
NPI:1598841983
Name:ILUORE, UDUAK REGINA (MD)
Entity Type:Individual
Prefix:
First Name:UDUAK
Middle Name:REGINA
Last Name:ILUORE
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 1:593 W 6TH ST
Mailing Address - Street 2:
Mailing Address - City:SAN PEDRO
Mailing Address - State:CA
Mailing Address - Zip Code:90731-2521
Mailing Address - Country:US
Mailing Address - Phone:310-547-0202
Mailing Address - Fax:310-547-5096
Practice Address - Street 1:593 W 6TH ST
Practice Address - Street 2:
Practice Address - City:SAN PEDRO
Practice Address - State:CA
Practice Address - Zip Code:90731-2521
Practice Address - Country:US
Practice Address - Phone:310-547-0202
Practice Address - Fax:310-547-5096
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2016-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA102157207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMI68192Medicare UPIN
NMP00378921OtherRAILROAD MEDICARE
NM15297801OtherHOBBS AHCCCS
NMNM001P88OtherBLUE CROSS BLUE SHIELD