Provider Demographics
NPI:1629208418
Name:IFEDIBA, FRANK MADUKA (RN)
Entity Type:Individual
Prefix:MR
First Name:FRANK
Middle Name:MADUKA
Last Name:IFEDIBA
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
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Mailing Address - Street 1:826 GLENWAY DR
Mailing Address - Street 2:
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90302-2711
Mailing Address - Country:US
Mailing Address - Phone:310-308-4094
Mailing Address - Fax:310-419-0840
Practice Address - Street 1:826 GLENWAY DR
Practice Address - Street 2:
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90302-2711
Practice Address - Country:US
Practice Address - Phone:310-308-4094
Practice Address - Fax:310-419-0840
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-15
Last Update Date:2009-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA569887163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health