Provider Demographics
NPI:1609871227
Name:EMERUWA, IHEANACHO (MD)
Entity Type:Individual
Prefix:DR
First Name:IHEANACHO
Middle Name:
Last Name:EMERUWA
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 1:9041 MAGNOLIA AVE
Mailing Address - Street 2:SUITE 305
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92503-3900
Mailing Address - Country:US
Mailing Address - Phone:951-343-3477
Mailing Address - Fax:951-347-8343
Practice Address - Street 1:9041 MAGNOLIA AVE
Practice Address - Street 2:SUITE 305
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92503-3900
Practice Address - Country:US
Practice Address - Phone:951-343-3477
Practice Address - Fax:951-347-8343
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-20
Last Update Date:2021-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA41038207R00000X, 207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ28499ZOtherMEDICARE PTAN #
CA00A410380Medicaid
CAA29279Medicare UPIN
CA00A410380Medicaid